Cerebral venous sinus thrombosis (cvst)

Posted by brittalisse @brittalisse, Jul 14, 2011

I was diagnosed with a CVST a year and a half ago. I've been doing well, but it is always on my mind. It is quite rare and I'm interested in hearing stories from anyone who has been through something similar.

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@fischel

Long overdue update.

Turns out that, on angiography, I do have a bit of a cobweb of dural AV fistulae, branching to and fro roughly from the right oropharynx to the back of the ole brain. Did the first embo in Jan. Was a good 6h in the attempt to gain enough arterial access (the anatomy of my medial meningeal artery, which is often more ideal for access to fistulae of this, does a kind of 'swoop down' versus an arching path toward the top of my head). That makes this particular entry quite the risk as it's current location very likely abuts a cranial nerve. So all we got out of that 6 hours (and a helluva post op headache) was a roughtly a middle third of the fistulae embolized, leaving 2 remaining segments, one toward the region where my right frontal sinuses would be (I"m a 5%'er - born w/out them 0 I'm not terribly worried about this one).

Good news after that procedure is that the PT was taken care of, and some of my focal issues, headaches, and nausea improved to a large degree.

In a second procedure in March, we decided to try and use a venous approach to coil embolize the more posterior junk that is more of the concern here. The reason is to stabilize the thrombosis in the transverse sinus and keep it from creeping toward the superior sagittal sinus (that outcome wouldn't be a cause for celebration). My neurovascular doc was kinda disappointed with it as the coils didn't appear to seal up blood flow from the fistulae located there as much as he had hoped.

Good news there is, at least I was symptomatically stable and we'd just have to wait and see if the posterior fistulae would just shrivel up and go poof. So we've taken a break from surgery, thankfully. A couple of weeks ago I was cleared to start jiu jitsu again, within reason (given I only have left side dominant drainage now - and the thrombosis is here to stay - I don't really have any redundancy in case I were to get caught in a choke - so tapping out before we really get there is the right answer).

We're resuming appts at the end of Aug, Another diagnostic angio soon to follow and see what next steps look like.

Today has been a bit messy as I've been having a bit of a 'brain zap-a-thon', followed by some dizziness (kinda prompted me to update my post in the hopes something in it may be useful to someone else). I've restarted Diamox - still remain on the Eliquis. Remaining hydrated, continuing exercise - may take a day off jiu jitsu tomorrow if I feel like today. Keeping a close eye on it and gave the fam a little heads up in case they see me in a rather absurd stated. Will see what new and interesting adventures tomorrow brings.

More to come - you all take care of yourselves and each other.

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Hello there I just read your post, and I am hoping you can help me. I saw a neurologist today as followup for a cvst. She swears a cvst is not a stroke. I know what we have is rare, but why doesn't this neurologist know this? I battle every single day with confusion, lack of memory, cold sweats, headaches, and not being able to find words as I am talking. She said she had no idea why I have these issues and didn't plan on taking it any further than that. I know it could be much worse, but it's so overwhelming. Why would this so called specialist say this? Other than she really doesn't know her job. Why is she practicing neurology medicine when she doesn't know the differences in strokes? Its very scary. Now i don't know what to do. I need care, but how many neurologists are out there that dismiss their patients concerns like this? I need someone that I can depend on. I don't want my butt kissed, but I truly need someone to pay attention. Thank you.

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@sandorclegane

Hello, I was diagnosed with CVST seven months ago. I had a sinus and ear infection and it turns out, bacterial meningitis. Doctors think one of those infections caused the blood clot to for in my brain. I would say I've made a full recovery minus my vision problems that persist. I have dark spots in each eye that I'm told are permanent, but one eye seems to do an adequate job of picking up what the other can't, it is at least manageable. What is increasingly difficult to manage is the fog I see through. I've tried to research this but haven't had much luck, it seems to be a result of the optic neuritis suffered due to the CVST. In full light, like mid-day, I can't see vibrant colors, it looks as though everything I see has been painted over with white. The more objects there are in sight, the more everything blends together. It's bad enough that I don't feel comfortable driving, even though my Opthalmologist cleared me to do so. My dad knows a lady who went through the same thing and she said the "fog" lifted after about a year and she got back to a semblance of normalcy. I was just curious to see if anyone else experienced this and if they had any luck with it getting better, as everyone knows, getting answers regarding CVST are exceedingly difficult. Thank you all for your stories.

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Hello there. I also have problems with my eyesight. I have difficulty with focusing on objects and being able to identify what they are at times. Not always, but sometimes. And also with things being blurry. I don't know why, but only sometimes. And there are too many days that I can't even drive due to that. It drives me nuts. I also have problems with cold sweats and still my memory too after 5 months. But if you are caucasian please get a test for Factor V Leiden blood clotting disorder. They discovered I have that mutation that causes blood to clot easily when I was in a coma from the cvst. And that was even after a TIA in 2021.

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Hello. I had a cvst in May 2023 after having a TIA in July of 2021. I also carry the Factor V Leiden blood clotting mutation, which was finally caught while in a coma for 3 days in May with the cvst. If you are white and of European decent please make your provider check you for that! I had no idea about my European decent, but if you've had a TIA or any kind of stroke, you need to be checked for that. It truly is a life saver. They let that slip through the cracks. My major problem is that my new neurologist swears a cvst is not a stroke. She is approx. 60, and I'm thinking she hasn't caught up to knowing enough about cvst. No, no problem with her age if she knew what she was doing. BTW, I am also 60. It really scares me to be honest. She also said she didn''t see brain damage on my scans when two minutes before that her assistant said they couldn't pull them up on the system. I already know there is damage. Even before the cvst/stroke, from severe migraines I suffered for decades. A previous neurologist showed my scans and slides to me showing the migraine damage. I almost lost my second son during pregnancy, which is now known to result from the Factor V blood clotting problem. Why doesn't this neurologist know this? I can't trust her knowing she's not going to treat me for what it is. I asked her why I still have problems with focusing and confusion, cold sweats, constant memory issues, weakness in my left hand and a problem with putting my left foot first, having to read a sentence over and over again to comprehend, etc, Her response was she didn't know and by her actions and responses, she certainly wasn't concerned about it. She was going to send me home not knowing any of these things until I brought up a skin condition that I have. My blood cells and skin cells clot and cause redness and a difference in texture. A dermotologist diagnosed that almost 10 years ago and told me its from blood cells and skin cells clotting, but that he had never seen it so badly spread. So i ask her why that's still happening when I am on blood thinners. Honestly, I knew she had no idea what I was talking about. Long story short, I can't trust a neurologist that doesn't know what she's dealing with. I don't know what to do. I know this was a stroke. I've spent countless hours doing research on this. I can't work at this point, so I have the time to do so. No. I don't have a medical degree, but I know what I read from outstanding medical organizations, institutions and universities. My daughter's cancer specialist from a groundbreaking university told me when I had the cvst to be sure to get a Doctor that treats it as a stroke and does whatever is necessary. He told me it is extremely important. He warned me ahead of time in essence, but I had no idea it would come to this. Is anyone else having problems with being treated for what our problems actually are after going through this? And to tell me she has no idea why I have these symptoms, and to move on at that point, is totally unacceptable. My whole life has been turned upside down. My husband has to call home from work to make sure I take my meds, and she has no idea and wasn't concerned. Medication that I need to stay alive, and I need reminded. I feel like I'm fighting a losing battle.

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Hello, I was diagnosed with CVST seven months ago. I had a sinus and ear infection and it turns out, bacterial meningitis. Doctors think one of those infections caused the blood clot to for in my brain. I would say I've made a full recovery minus my vision problems that persist. I have dark spots in each eye that I'm told are permanent, but one eye seems to do an adequate job of picking up what the other can't, it is at least manageable. What is increasingly difficult to manage is the fog I see through. I've tried to research this but haven't had much luck, it seems to be a result of the optic neuritis suffered due to the CVST. In full light, like mid-day, I can't see vibrant colors, it looks as though everything I see has been painted over with white. The more objects there are in sight, the more everything blends together. It's bad enough that I don't feel comfortable driving, even though my Opthalmologist cleared me to do so. My dad knows a lady who went through the same thing and she said the "fog" lifted after about a year and she got back to a semblance of normalcy. I was just curious to see if anyone else experienced this and if they had any luck with it getting better, as everyone knows, getting answers regarding CVST are exceedingly difficult. Thank you all for your stories.

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@fischel

Such a strange brew this condition is :).

My own history - I'm an active 50.5 yo male. Never a smoker. Drink ultra-ocassionally (1-2oz scotch about 1x/month). An extraordinary wife of what will be 20yrs in June. Trifecta of boys. We all take the 'Buckaroo Banzai' approach to life - going in 20 different directions at once. We train in brazilian jiu-jitsu (and I workout/stretch/etc on other days just to deal with THAT :)). Since my recent diagnosis, I've gone on leave working as a PA (head/neck surgery - ironically) and continuing with the same group in translational search (mostly maths/stats modeling).

Diagnostic backdrop:
About 6+ wks ago I began noticing a pulsating sound in my right ear. No other symptoms. At first it was barely noticeable. Kinda chalked it up to some of the facial pressure one feels during a bout of sinusitis - either that or perhaps a bit of ear barotrauma while teaching my kids how to scuba dive (I'm a diving instructor on the side).

2 weeks pass and the sound is more noticeable with the characteristic 'whooshing' sound you would notice with pulsatile tinnitus (PT)). Given my tenure in medicine, I knew this was a symptom we'd need to explore sooner rather than later (which is why I'm also interested in having my case presented in a study where PT may be evaluated as another landmark symptom of CVST).

CT:
My CT scan revealed right transverse-sigmoid CVST with 'possible' stricture around the C-5 cervical spine level of the right internal jugular vein (RIJV). Funny that I had just had a fusion at C4-C5 in March of this year. Maybe a relationship, but not yet convinced.

My own doc started me on Eliquis immediately.

When I view the CT images and do some of the recon work, it looks to me like the RIJV is likely a bit too narrow in size in the first place ('hypoplastic'). Visualizing the vessel below C5 is iffy at best, so difficult to confirm the radiologist's interpretation of possible RIJV stricture there. Kinda need more info into that and the overall anatomy of the RIJV, but we have a more immediate need to address (see possible AV fistula below).

MRV:
Follow up MRV about 2 wks ago revealed right partial thrombosis of the transverse sinus all the way to the confluence (where the superior sagittal sinus [SSS] and transverse sinuses [TS] meet). Drainage flow was robust predominantly down the left sinuses into the LIJV. This makes sense, my particular anatomic variation of the confluence [type 2aII with favor toward the left transverse sinus] is physically more inclined toward left sided drainage. But there's also an odd 'kink' (more like a corkscrew shape) just to the right of where the right transverse sinus ties into the confluence. Not convinced this is remarkable either, but amusing at least.

The Logjam:
Things get more problematic downstream: there's complete blockage of the right sigmoid sinus into the right internal jugular. And it looks like there's been some accessory vessel recruitment peripheral to the sigmoid sinus on the MRV, but nothing emptying into the RIJV. One of those vessels appears to be a cortical artery (really strong signal on MRV). Possibly an arterio-venous fistula (AVF) there which we're gonna have to confirm w angiogram in 3 weeks.

Some requisite lit review and thoughts:
So ok, my current gestalt is that right sided sinus drainage may never have been in the greatest position to do its job IF the RIJV is perhaps underdeveloped .... but that's still TBD. No hypercoag tests just yet. We'll get there. Probably not a bad time to get them during the angio.

Given the sheer length of the thrombosis, re-opening the pipe seems a bit of a shot-in-the-dark. There are a few case studies demo'ing the use of aggressive IV heparin / then warfarin by mouth in recanalizing the IJV (some patients who also underwent mechanical thrombectomy. I don't think this has been determined to be extraordinarily successful beyond 8 weeks in the lit. But those comprise barely a handful of case-studies. And again, how 'chronic' my particular trainwreck may be is kinda hard to tell at the moment.

Dealing with the more critical issue of a possible AVF has to come first. The treatment plan after that, well, we'll see. I'm not exactly encouraged by what I'm seeing and what my vascular neurologist has confirmed (he's as doubtlful of recanalization as I am, but I think post angiogram and any AV fistula repair I'd like to give it a reasonable shot).

I'll post some notes post angio. Maybe someone else may find a similar sequence of events that might be helpful in Dx/Rx. Happy to answer any Q's.

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Long overdue update.

Turns out that, on angiography, I do have a bit of a cobweb of dural AV fistulae, branching to and fro roughly from the right oropharynx to the back of the ole brain. Did the first embo in Jan. Was a good 6h in the attempt to gain enough arterial access (the anatomy of my medial meningeal artery, which is often more ideal for access to fistulae of this, does a kind of 'swoop down' versus an arching path toward the top of my head). That makes this particular entry quite the risk as it's current location very likely abuts a cranial nerve. So all we got out of that 6 hours (and a helluva post op headache) was a roughtly a middle third of the fistulae embolized, leaving 2 remaining segments, one toward the region where my right frontal sinuses would be (I"m a 5%'er - born w/out them 0 I'm not terribly worried about this one).

Good news after that procedure is that the PT was taken care of, and some of my focal issues, headaches, and nausea improved to a large degree.

In a second procedure in March, we decided to try and use a venous approach to coil embolize the more posterior junk that is more of the concern here. The reason is to stabilize the thrombosis in the transverse sinus and keep it from creeping toward the superior sagittal sinus (that outcome wouldn't be a cause for celebration). My neurovascular doc was kinda disappointed with it as the coils didn't appear to seal up blood flow from the fistulae located there as much as he had hoped.

Good news there is, at least I was symptomatically stable and we'd just have to wait and see if the posterior fistulae would just shrivel up and go poof. So we've taken a break from surgery, thankfully. A couple of weeks ago I was cleared to start jiu jitsu again, within reason (given I only have left side dominant drainage now - and the thrombosis is here to stay - I don't really have any redundancy in case I were to get caught in a choke - so tapping out before we really get there is the right answer).

We're resuming appts at the end of Aug, Another diagnostic angio soon to follow and see what next steps look like.

Today has been a bit messy as I've been having a bit of a 'brain zap-a-thon', followed by some dizziness (kinda prompted me to update my post in the hopes something in it may be useful to someone else). I've restarted Diamox - still remain on the Eliquis. Remaining hydrated, continuing exercise - may take a day off jiu jitsu tomorrow if I feel like today. Keeping a close eye on it and gave the fam a little heads up in case they see me in a rather absurd stated. Will see what new and interesting adventures tomorrow brings.

More to come - you all take care of yourselves and each other.

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@tacucrist

I was on heparin for 2 weeks, than Rivaroxaban for 2 months that I switched to Apixaban hoping that dizziness will disappeared. After almost 3 months I still have disequilibrium when moving. How is your diziness - better , worse ? Thanks

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My dizziness is pretty bad most days. I have really bad pain in my head when bending forwarding. The headaches are still brutal. I have constant whooshing sounds in my ear and feel off. Hoping for some relief soon. I’m now being told I have super imposed Stenosis in my brain that is causing intercranial hypertension due to the lack of blood flow.

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@lakeyshialyons

Good morning, my name is LaKeyshia and I was diagnosed with CVST on last week and I also have IHH. I have experiencing whooping in my ears, face pain, severe headaches, nausea, vomiting, vision problems and over all ill. After we received my MRI & MRV results (revealed complete thrombosis of the left transverse sinus) the neurologist placed me on plavix and Hydrochlorothazide. I am having really bad headaches nausea dizziness vomiting and just over all ill. I have never had high blood pressure before but My blood pressure has been extremely high for the past couple of week even with taking this new blood pressure medicine Hydrochlorothazide I notice most women on this post were hospitalized and treated with heparin. I’m curious if this course of treatment I am on plavix is aggressive enough. Is anyone being treated with Plavix? I am terrified and extremely stressed out about this diagnosis. Does the clot dissolve or go away or is this a permanent condition. Has anyone had the clot complete go away? I also sent in my records to the Mayo Clinic in to get a second opinion. Any suggestions or information would be greatly appreciated.

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I was on heparin for 2 weeks, than Rivaroxaban for 2 months that I switched to Apixaban hoping that dizziness will disappeared. After almost 3 months I still have disequilibrium when moving. How is your diziness - better , worse ? Thanks

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I also forgot to mention that 3 months into my diagnosis, I started getting seizures and was started on Keppra.

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Hello. My name is Domingas. I'm 33 years old. I'm From RI. At 8 Months pregnant I was experiencing daily headaches that wouldn't go away and had difficulty walking. I complained to my OBGYN of the symptoms I was experiencing and my Obgyn promised me that it must be pregnancy related and continued to send me home each time. Fast forward 3 weeks later on 7/15/22 I delivered a healthy baby boy. 3 hours after delivery I suffered a thunderclap migraine and It got worse every time I stood up. I complained to the doctors and nurses for 12 hours of my symptoms and I was ignored each time stating that I just delivered a baby, and my symptoms are related to that. I demanded further testing since my symptoms wasn't improving. On 7/16/22 I went for a MRI and MRV and when my test results came back a few hours later I was surrounded by so many doctors that I started crying thinking I was Dying. I was diagnosed with CVST and a CSF leak at the same time. MRI Results: Vasculature: Abnormally distended and hypointense anterior one third of the superior sagittal sinus. Postcontrast MR imaging demonstrates mural enhancement with a tubular filling defect. MR venography of the BRAIN: There is abnormal flow in the anterior one third of the superior sagittal sinus. I spent 2 weeks in the hospital and while I was in the Hospital I was put on Heparin (IV) and after 3 days I was switched to Lovenox injections 120 mg 2x daily for 6 months due to breast feeding. After 6 months I was switched to Eliquis 5mg for 4 months Due to developing ulcers from the needles which at that point I stopped breast feeding. I saw a hematologist and he stated that the blood clot developed during pregnancy and there is no need to do further testing. It's been 10 months and the blood clot has finally dissolved but I'm experiencing memory loss and I'm super irritable and did I fail to mention that I'm also dealing with Post Partum depression. I want to get a 2nd opinion from a different Neurologist about the memory loss and the irritability.

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@moondusk

Hello, I was diagnosed with a CVST in December, 2020 at the age of 69 years. The CVST partially occluded the left transverse and left sigmoid sinus. The CVST was found after a CAT scan was done on my head/brain due to long standing issues with internal vibrations. I was prescribed Eliquis. About a month later, I started having increasing discomfort from headaches. Another CAT scan indicated a Dural Arteriovenous Fistula. It was confirmed by an MRV and MRA. They also discovered there was retrograde venous drainage. I had angiogram procedure to help determine a treatment approach. Two days later I had another angiogram during which time I had an embolization with Onyx. The doctors explained that the fistula was a mess. They prepared me for a six hour procedure followed by intensive care. Then another six hour surgery at some point and another intensive care stay. My neurosurgeons, Dr. Ray and Dr. Stevens at University Hospital in Cleveland, Ohio and the rest of my treatment team were amazing! The procedure took two hours and there was no intensive care. I was on the road to recovery over the past year and looking forward to getting off Eliquis. However, I again began having headaches and numbness on the left side of my face and neck discomfort. Three weeks ago, I had another MRV that showed that the clot was now occluding the Sigmoid and Transverse Sinus and also my internal Jugular Vein. I have an appointment with my vascular neurologist next week to discuss further treatment options. Waiting is difficult! I continue to have increasing symptoms. I am so glad, I found this group!

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Hi !
Sorry to hear about this. Did you develop an extended clot in the jugular vein despite treatment with Eliquis? Thank you in anticipation for your answer.

Cristina ( CVST diag in March 2023)

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