Cerebral venous thrombosis

T. Mary Vincila1*, Subathra Devi. M2, Maha Lakshmi B3

1Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

Cerebral Venous Thrombosis is an uncommon form of stroke caused by thrombosis of the cerebral veins and dural sinuses. It predominantly affects young adults, especially women with risk factors such as pregnant, puerperium, and oral contraceptive use. The clinical presentation is highly variable, ranging from isolated headache to focal neurological deficits, seizures and altered consciousness.

Key words: Cerebral Venous Thrombosis; Dural sinuses; Cerebral veins

Introduction

CVT is a rare but important type of stroke that occurs due to the formation of a blood clot in the cerebral veins or dural venous sinuses. CVT affects the venous drainage system of the brain, leading to impaired blood outflow, increased intracranial pressure, and possible brain tissue damage. CVT can occur in individuals of all age groups but is more commonly seen in young adults and women, especially during pregnancy or with the use of oral contraceptives.

Case presentation

Mrs. Kanishka 27years old hypothyroid, who had conceived for the first time during August 2025, detected to have hypertension, diabetes, following pregnancy, underwent D&C for missed abortion, on 75days of conception & started on oral contraceptive pills for past 2months, now presented with acute headache and left vision disturbance. On arrival the patient was conscious, oriented, afebrile, pupils 1.5mmRTL, GCS: E4V5M6 had no focal neurological deficit, Left hemianopia noted and stable vitals.  

Social history: Nil

Allergies: Not known medicine or environmental allergies.

Past Medical History: She was known to have Diabetic mellitus, hypertension, and hypothyroidism treatment.

Past Surgical History: Nil

Physical Examination

Vital signs

Patient conscious, oriented, afebrile

Pupils1.5mmRTL
Temp98’F
HR84beats /min
BP130/90mmhg
Spo298%s
GCSE4V5M6

Relevant Investigation

DateTestResults
03.12.2025INR0.97
08.12.2025INR1.09
10.12.2025INR1.69
12.12.2025INR4.01
03.12.2025PT11.3sec
08.12.2025PT11.7Sec
10.12.2025PT19.5Sec
12.12.2025PT45.6Sec
03.12.2025APTT26.03sec
08.12.2025APTT27.0sec
10.12.2025APTT11.7Sec
12.12.2025APTT11.7Sec

Fig (1): MRI OF Brain -Plain with MRA AND MRV (2.12.2025). MRI Brain plain with MRA & MRV done showed acute cerebral venous thrombosis involving right transverse & sigmoid sinuses. Focal area of T2/flair hyper intensity without diffusion restriction in right occipital lobe with Gyral edema-S/o vasogenic oedema

Diagnosis: Cerebral Venous Thrombosis

Management

Neuro physician & hematologist advice sought APLA work up sent & started on LMWH. DNA concept panel by NGS. FISH 5(9.22) sent, report awaited. Neuro physician opinion obtained for advised increased anticoagulant, APLA profile. Hematologist opinion obtained for APLA work up, Ophthalmologist opinion obtained for vision disturbance. General physician opinion obtained for systemic hypertension & glycemic control & orders carried out. Endocrinologist opinion obtained for hypothyroidism & managed. Abdomen scan done showed no significant abnormality detected. LUPUS anticoagulant was positive. LMWH bridged with Acitrom and therapeutic dose of Vit-k was maintained by monitoring PT, INR levels. Relevant opinion obtained and orders carried out. Follow-up CT-Brain done showed hemorrhagic infarct right occipital cortex, multiple calcified granulomas. She was treated with antiepileptic, PPI, analgesic, antihypertensive, OHA, anticoagulants and other supportive measures. Improving symptomatically & discharged with medicine.

Outcome

Vital are normal, patients return to normal daily activities, completely recovered from the neurological deficit and got discharged with good condition

Nursing Management

Pain Management

  • Pain level assessed regularly
  • Administered analgesics prescribed
  • A calm, quiet environment Provided
  • Vital signs Assessed (BP, pulse, respiratory rate, temperature)

Neurological Monitoring

  • GCS level assessed regularly
  • Pupils size and reaction checked frequently
  • Monitor for increased intracranial pressure (headache, vomiting, confusion)

Seizure Precautions

  • Maintained seizure safety measures:
  • Side rails provided
  • Ensure medication compliances
  • Patient monitored Closed for any Seizures activity

Circulation

  • Observed for bleeding complications.
  • Administered anticoagulants as prescribed
  • Monitored for signs of hemodynamic instability

Discharge medications

S.noDrugDosageFrequency
1Tab. Levipil500mgTDS
2Tab. Pan40mgBD
3Tab. Dolo650mgTDS
4Tab. Clonotril0.25mgOD
5Nasal Spray-TDS
6Tab. Dapamac Trio10/100/500OD
7Tab. Obimet SR500mgOD
8Tab. Nebivolol5mgOD
9Tab. Thyronorm100mcgOD
10Tab. Rosuvas10mgOD

Discussion

CVT is a potentially reversible neurological condition if identified early. A multidisciplinary approach involving prompt diagnosis, effective medical therapy, and vigilant nursing care plays a vital role in ensuring favorable patient outcomes.

Conclusion

Cerebral Venous Thrombosis is a rare but treatable cause of stroke with varied clinical features. Early diagnosis and prompt anticoagulant therapy significantly improve outcomes and reduce complications. Early recognition through appropriate neuroimaging and prompt initiation of anticoagulant therapy are essential for favorable outcomes. Increased awareness among healthcare professionals is crucial to reduce delays in diagnosis and improve overall prognosis.

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