Thrombosis of the cerebral veins and sinuses.

N Engl J Med 2005;352:1791-8. Copyright © 2005 Massachusetts Medical Society. hrombosis of the cerebral veins and sinuses is a distinct cerebrovascular disorder that, unlike arterial stroke, most often affects young adults and children. The symptoms and clinical course are highly variable. A teenager who has had recent headaches after starting oral contraception, a woman who has had seizures after delivery in the obstetrical ward, and a comatose man with a dilated pupil in the emergency room all may have sinus thrombosis. The estimated annual incidence is 3 to 4 cases per 1 million population and up to 7 cases per 1 million among children. About 75 percent of the adult patients are women. During the past decade, increased awareness of the diagnosis, improved neuroimaging techniques, and more effective treatment have improved the prognosis. More than 80 percent of all patients now have a good neurologic outcome. This review summarizes recent insights into the pathogenesis of sinus thrombosis, risk factors, and clinical and radiologic diagnosis and discusses the current evidence and controversies about the best treatment.