Dural venous sinus thrombosis or 'DVST',  is a sporadic but fatal disorder that affects the sinus veins in the brain. Here's what to know about the medical condition.

Dural venous sinus thrombosis (DVST) causes a blockage of a venous sinus, causing the blood from the sinus to be transferred to the brain. The condition can cause hematoma formation in the brain, which generally leads to massive brain damage.

The cause of thrombosis is often unknown, but it is often associated with anticoagulant therapy (such as warfarin).

However, you might be surprised to find that anticoagulation therapy has proven to be an effective and safe dural sinus thrombosis treatment.  

What are the symptoms of dural sinus thrombosis?

The clinical symptoms od DVST are diverse and depend on the location of the clot. Seeking medical attention as soon as you discover any of the following symptoms maximizes one's chances of recovering. 

• Severe headache
• Typical stroke symptoms
• Blurred vision
• Seizures
• Coma
• Losing consciousness
• Memory loss or loss of speech unexpectedly, depending on which part of the dural sinus is affected.
• Loss of control over movement in part of the body

The disease can cause serious problems, such as paralysis and even death. 

Who's at risk for dural venous sinus thrombosis?

Dural sinus thrombosis mainly affects the elderly and those with underlying illnesses. In about 10% of all the cases, the disease results from nasal sinus or infection of the year.

However, in many cases, the disease occurs due to multiple factors which are extremely variable. These include:

• Certain conditions that predispose to this condition like high blood pressure, diabetes, and pregnancy
• Certain medications that are prescribed to prevent this condition like warfarin, anticoagulants, and antithrombotics
• Specific medical procedures that can cause this condition, such as deep vein thrombosis (DVT)

However, the risk factors in children and adults widely differ. 

The risk factors for children and infants include:

• Iron deficiency
• Sickle cell anemia
• Problem with how their blood forms clots
• Heart disease
• Beta-thalassemia major
• Chronic hemolytic anemia
• Head injury
• Dehydration
• A mother who has had infections during pregnancy or has a history of infertility could cause the disease in a newborn.

Risk factors in adults include:

• Pregnancy and the first few weeks after delivery
• Cancer
• Obesity
• Collagen vascular diseases such as lupus, Behcet syndrome, or Wegener’s granulomatosis
• Blood clotting problems such as protein C and S deficiency, factor V Leiden mutation, and lupus anticoagulant
• Low blood pressure in the brain
• Inflammatory bowel diseases

General Diagnosis

If you experience any of the above symptoms and check to the emergency room, the doctor will give you a full neurological scan and a brain CT scan. The CT scan shows the areas of your brain that are bleeding.

If the scan shows bleeding in the brain, you will undergo surgery to drain the blood. 

The doctor will then perform magnetic resonance venography, or 'MRV', to diagnose dural sinus thrombosis. MRV is a diagnostic imaging test similar to an MRI, but it is dedicated to showing blood in the brain’s blood vessels and in the skull.

If the doctor has no access to MRV, they can use a CT angiography to visualize the dural sinuses. 

How is dural sinus thrombosis treated?

If diagnosed with dural sinus thrombosis, you need to get early treatment to prevent fatal consequences. A dural sinus thrombosis treatment plan should be done in a hospital, and could include:

Medical Treatment for DVST

After a positive dural sinus thrombosis diagnosis, the doctor may put you under long-term medication using blood thinners such as heparin, Lovenox, or coumadin.

These medicines effectively prevent the formation of new blood clots or enlargement of the existing ones, which could potentially lead to stroke.

Surgical Treatment for DVST

If you are experiencing heavy bleeding in the brain due to dural sinus thrombosis, the doctor may recommend undergoing surgery to remove the blood. If the bleeding is not stopped in time, it could compress some vital structures in the brain, leading to permanent disability and sometimes death. 

In addition to these dural sinus thrombosis treatment options, you may also get:

• Antibiotics if you have an infection
• Fluids 
• Medicines to control seizures
• Monitoring and controlling the bleeding in your head
• Monitoring of the brain activity
• Measuring your the eyesight and monitoring changes
• Rehabilitation

Some experts dispute the use of anticoagulants and antithrombotics in treating dural sinus thrombosis. The use of these drugs is believed to be detrimental to patients because it can reduce the clot formation ability of the blood due to its short half-life and its possible side effects.

How can I prevent dural sinus thrombosis?

The possibility of preventing this disease should be a top driver for healthy eating and overall lifestyle behaviors.  Leading a heart-healthy lifestyle goes a long way in preventing the disease:

• Exercising daily
• Maintaining a low-fat diet, including fruits and vegetables
• Stopping cigarette smoking
• Leading a healthy lifestyle to control chronic health conditions such as diabetes

If dural sinus thrombosis affects your brain, you can still recover and stay healthy depending on how it has affected your brain. A healthy diet and regular exercise can help you lead a normal life. 

Your doctor will guide you on the types of medicines you should not take after suffering from the disease, but most importantly, you should keep off birth control pills as they increase the risk of blood clots. 

If you have lost your speech or physical movement due to the disease, you may need to sign up for a special rehab program. In addition, you should consider seeking a specialist's services if you are experiencing symptoms such as severe headache or blurred vision. 

Final Thoughts - DVST is rare, but a very serious condition

Although dural sinus thrombosis sounds fatal and scary, it’s very rare, affecting about five people in 1 million every year. If you or your loved one shows any of the discussed symptoms, you should immediately check into an emergency room.

Dural sinus thrombosis treatment plans discussed above are effective, with about 80% of the patients recovering fully. However, their effectiveness depends on the severity of the stroke, whereby it may take weeks or months to recover.

During recovery, you may experience prolonged symptoms such as headaches and seizures in some instances. If that’s the case, you should go for regular checkups with your doctor for monitoring!

After treatment, ensure you take your medicine as prescribed by your doctor and maintain a healthy lifestyle that includes a proper diet, exercising, and cutting off smoking. If need be, check in to a rehabilitation center or physical therapy to help you regain your speech and movement. 

If you have any questions, or would like to schedule an appointment with one of LAIIC's Los-Angeles-based radiologists, please book time with us today.