The patients often have hypercoagulable risk factors (cancer, recent oral contraceptive use, and pregnancy) and may present with headaches, seizures, or decreased level of consciousness due to either venous ischemic or hemorrhagic complications. Unlike other stroke etiologies, the presence of ICH is often not a contraindication to anticoagulation but necessitates serial assessment for hematoma development and/or expansion in the acute and early subacute phases in this patient population. An early follow-up is recommended in patients with CVT with persistent or evolving symptoms despite medical treatment or with symptoms suggestive of propagation of thrombus. In patients with previous CVT who present with recurrent symptoms suggestive of CVT, repeat imaging is also recommended. Serial follow-up at 3 to 6 months after diagnosis is used to assess for recanalization of the occluded cortical vein/sinuses in stable patients. However, recommendations for duration of anticoagulation are not based on the presence or absence of recanalization [99,105]. In the delayed setting, CVT may be complicated by dural arteriovenous fistula, which may necessitate delayed arterial imaging. Arteriography Cervicocerebral Catheter-directed cerebral angiography and venography are infrequently necessary in the setting of dural venous sinus thrombosis due to the sensitivity and specificity of CTV and MRV. In the setting of progressive infarct despite adequate medical therapy, catheter-directed angiography and venography may be useful for the identification of endovascular treatment targets or definitive evaluation for dural arteriovenous fistula development, which may complicate CVT. CT Head Perfusion With IV Contrast Some studies demonstrate a possible role for perfusion imaging in prognostic evaluation of the ischemic penumbra in the setting of CVT [100]. In ongoing surveillance, however, the role for perfusion imaging is limited.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. The patients often have hypercoagulable risk factors (cancer, recent oral contraceptive use, and pregnancy) and may present with headaches, seizures, or decreased level of consciousness due to either venous ischemic or hemorrhagic complications. Unlike other stroke etiologies, the presence of ICH is often not a contraindication to anticoagulation but necessitates serial assessment for hematoma development and/or expansion in the acute and early subacute phases in this patient population. An early follow-up is recommended in patients with CVT with persistent or evolving symptoms despite medical treatment or with symptoms suggestive of propagation of thrombus. In patients with previous CVT who present with recurrent symptoms suggestive of CVT, repeat imaging is also recommended. Serial follow-up at 3 to 6 months after diagnosis is used to assess for recanalization of the occluded cortical vein/sinuses in stable patients. However, recommendations for duration of anticoagulation are not based on the presence or absence of recanalization [99,105]. In the delayed setting, CVT may be complicated by dural arteriovenous fistula, which may necessitate delayed arterial imaging. Arteriography Cervicocerebral Catheter-directed cerebral angiography and venography are infrequently necessary in the setting of dural venous sinus thrombosis due to the sensitivity and specificity of CTV and MRV. In the setting of progressive infarct despite adequate medical therapy, catheter-directed angiography and venography may be useful for the identification of endovascular treatment targets or definitive evaluation for dural arteriovenous fistula development, which may complicate CVT. CT Head Perfusion With IV Contrast Some studies demonstrate a possible role for perfusion imaging in prognostic evaluation of the ischemic penumbra in the setting of CVT [100]. In ongoing surveillance, however, the role for perfusion imaging is limited.