In this patient which risk factor is most likely present?
The oral contraceptive pill is the most common risk factor in this group of patients.
What are some other risk factors to be considered?
Hormonal (oral contraceptive pill, pregnancy, puerperium, steroids); prothrombotic haematological conditions; local factors (compressing mass, infection (especially mastoid sinus)); systemic illness (dehydration, sepsis, malignancy, connective tissue disorders). Despite all of these risk factors approximately 12.5% remain idiopathic.
What is the mainstay of therapy and what is the prognosis?
The mainstay of treatment is heparin, even in the setting of haemorrhagic venous infarction. The natural history of cerebral venous thrombosis is highly variable, with some patients having minimal or no symptoms and an uneventful recovery ( ~ 65%), whereas others have a fulminant course culminating in extensive venous infarction and dependency or death (~20%).
Thrombosed hyperdense superior sagittal sinus (SSS), straight sinus (SS), vein of Galen (VOG), transverse sinus (TS) on the left and a number of cortical veins (CV). In addition the inferior sagittal sinus (ISS) is not visualised on CT venogram and is presumably also thrombosed (or hypoplastic). A region of low density with foci of haemorrhage (yellow dotted line) is noted in the partial lobe on the right consistent with a venous infarct.