61. Lansberg MG, O'Donnell MJ, Khatri P, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e601S. 62. Preter M, Tzourio C, Ameri A, Bousser MG. Long-term prognosis in cerebral venous thrombosis. Follow-up of 77 patients. Stroke 1996; 27:243. 63. Ferro JM, Correia M, Rosas MJ, et al. Seizures in cerebral vein and dural sinus thrombosis. Cerebrovasc Dis 2003; 15:78. 64. S nchez van Kammen M, Lindgren E, Silvis SM, et al. Late seizures in cerebral venous thrombosis. Neurology 2020; 95:e1716. 65. Bossoni AS, Peres MFP, Leite CDC, et al. Headache at the chronic stage of cerebral venous thrombosis. Cephalalgia 2022; 42:1476. 66. Farb RI, Vanek I, Scott JN, et al. Idiopathic intracranial hypertension: the prevalence and morphology of sinovenous stenosis. Neurology 2003; 60:1418. 67. Higgins JN, Gillard JH, Owler BK, et al. MR venography in idiopathic intracranial hypertension: unappreciated and misunderstood. J Neurol Neurosurg Psychiatry 2004; 75:621. 68. Higgins JN, Owler BK, Cousins C, Pickard JD. Venous sinus stenting for refractory benign intracranial hypertension. Lancet 2002; 359:228. https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis/print 24/33 7/6/23, 12:28 PM Cerebral venous thrombosis: Treatment and prognosis - UpToDate 69. Owler BK, Parker G, Halmagyi GM, et al. Pseudotumor cerebri syndrome: venous sinus obstruction and its treatment with stent placement. J Neurosurg 2003; 98:1045. 70. Tsumoto T, Miyamoto T, Shimizu M, et al. Restenosis of the sigmoid sinus after stenting for treatment of intracranial venous hypertension: case report. Neuroradiology 2003; 45:911. 71. Ferro JM, Lopes MG, Rosas MJ, et al. Long-term prognosis of cerebral vein and dural sinus thrombosis. results of the VENOPORT study. 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Stroke 2014; 45:1545. 78. Aguiar de Sousa D, Canh o P, Ferro JM. Safety of Pregnancy After Cerebral Venous Thrombosis: A Systematic Review. Stroke 2016; 47:713. 79. Canh o P, Ferro JM, Lindgren AG, et al. Causes and predictors of death in cerebral venous thrombosis. Stroke 2005; 36:1720. 80. Borhani Haghighi A, Edgell RC, Cruz-Flores S, et al. Mortality of cerebral venous-sinus thrombosis in a large national sample. Stroke 2012; 43:262. 81. Coutinho JM, Zuurbier SM, Stam J. Declining mortality in cerebral venous thrombosis: a systematic review. Stroke 2014; 45:1338. 82. Kenet G, Kirkham F, Niederstadt T, et al. Risk factors for recurrent venous thromboembolism in the European collaborative paediatric database on cerebral venous thrombosis: a multicentre cohort study. Lancet Neurol 2007; 6:595. 83. Ferro JM, Bacelar-Nicolau H, Rodrigues T, et al. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. 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Topic 1109 Version 45.0 https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis/print 26/33 7/6/23, 12:28 PM Cerebral venous thrombosis: Treatment and prognosis - UpToDate GRAPHICS Placebo-controlled randomized trials of anticoagulants in acute cerebral venous thrombosis Einh upl et al 1991, intravenous heparin versus placebo Heparin versus placebo Outcome at three months Heparin group (n = 10) Total recovery 8 patients Residual motor deficit 2 patients Placebo group (n = 10) Total recovery 1 patient Minor residual deficit 6 patients Deaths 3 patients De Bruijn and Stam 1999, subcutaneous nadroparin versus placebo Outcome difference Nadroparin (n = 30) Placebo (n = 29) Risk difference At three weeks Deaths 2 4 BI score <15 4 3 Death or BI <15 6 (20 percent) 7 (24 percent) 4 percent (95% CI, 25 to 17 percent) At 12 weeks Deaths 2 4 Dependent (OHS 2 2 3 to 5) Death or dependent 4 (13 percent) 6 (21 percent) 7 percent (95% CI, 26 to 12 percent) BI: Barthel Index; OHS: Oxford Handicap Score. Data from: 1. Einh upl KM, Villringer A, Meister W, et al. Heparin treatment in sinus venous thrombosis. Lancet 1991; 338:597. 2. de Bruijn SF, Stam J. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke 1999; 30:484. Graphic 69484 Version 7.0 https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis/print 27/33 7/6/23, 12:28 PM Cerebral venous thrombosis: Treatment and prognosis - UpToDate Systemic and local conditions increasing the risk of cerebral venous thrombosis Transient risk factors Infection Central nervous system Ear, sinus, mouth, face, and neck Systemic infectious disease Pregnancy and puerperium Dehydration Mechanical precipitants Head injury Lumbar puncture Neurosurgical procedures Jugular catheter occlusion Drugs Oral contraceptives Hormone replacement therapy Androgens Asparaginase Tamoxifen Glucocorticoids Permanent risk factors Inflammatory diseases Systemic lupus erythematosus Beh et disease Granulomatosis with polyangiitis Thromboangiitis obliterans Inflammatory bowel disease Sarcoidosis Malignancy Central nervous system https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis/print 28/33 7/6/23, 12:28 PM Cerebral venous thrombosis: Treatment and prognosis - UpToDate Solid tumour outside central nervous system Hematologic Hematologic condition Prothrombotic states, genetic or acquired Protein C deficiency Protein S deficiency Antithrombin deficiency Factor V Leiden mutation G20210A prothrombin gene mutation Antiphospholipid syndrome Myeloproliferative neoplasms Nephrotic syndrome Paroxysmal nocturnal hemoglobinuria Hyperhomocysteinemia Polycythemia, thrombocythemia Severe anemia, including paroxysmal nocturnal hemoglobinuria Central nervous system disorders Dural fistulae Other disorders Congenital heart disease Thyroid disease Graphic 65303 Version 10.0 https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis/print 29/33 7/6/23, 12:28 PM Cerebral venous thrombosis: Treatment and prognosis - UpToDate Glasgow Coma Scale and Pediatric Glasgow Coma Scale Glasgow Coma [2] Sign Pediatric Glasgow Coma Scale Score [1] Scale Eye opening Spontaneous Spontaneous 4 To command To sound 3 To pain To pain 2 None None 1 Verbal Oriented Age-appropriate vocalization, smile, or orientation to 5 response sound; interacts (coos, babbles); follows objects Confused, disoriented Cries, irritable 4 Inappropriate words Cries to pain 3 Incomprehensible sounds Moans to pain 2 None None 1 Motor Obeys commands Spontaneous movements (obeys verbal command) 6 response Localizes pain Withdraws to touch (localizes pain) 5 Withdraws Withdraws to pain 4 Abnormal flexion to Abnormal flexion to pain (decorticate posture) 3 pain Abnormal extension to pain Abnormal extension to pain (decerebrate posture) 2 None None 1 Best total score 15 The Glasgow Coma Scale (GCS) is scored between 3 and 15, with 3 being the worst and 15 the best. It is composed of 3 parameters: best eye response (E), best verbal response (V), and best motor response (M). The components of the GCS should be recorded individually; for example, E2V3M4 results in a GCS of 9. A score of 13 or higher correlates with mild brain injury, a score of 9 to 12 correlates with moderate injury, and a score of 8 or less represents severe brain injury. The Pediatric Glasgow Coma Scale (PGCS) was validated in children 2 years of age or younger. Data from: 1. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2:81. 2. Holmes JF, Palchak MJ, MacFarlane T, Kuppermann N. Performance of the pediatric Glasgow coma scale in children with blunt head trauma. Acad Emerg Med 2005; 12:814. https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis/print 30/33 7/6/23, 12:28 PM Cerebral venous thrombosis: Treatment and prognosis - UpToDate Graphic 59662 Version 14.0 https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis/print 31/33 7/6/23, 12:28 PM Cerebral venous thrombosis: Treatment and prognosis - UpToDate Modified Rankin Scale Score Description 0 No symptoms at all 1 No significant disability despite symptoms; able to carry out all usual duties and activities 2 Slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance 3 Moderate disability; requiring some help, but able to walk without assistance 4 Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance 5 Severe disability; bedridden, incontinent, and requiring constant nursing care and attention 6 Dead Reproduced with permission from: Van Swieten JC, Koudstaa PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19:604. Copyright 1988 Lippincott Williams & Wilkins. Graphic 75411 Version 13.0 https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis/print 32/33 7/6/23, 12:28 PM Cerebral venous thrombosis: Treatment and prognosis - UpToDate Contributor Disclosures Jos M Ferro, MD, PhD Grant/Research/Clinical Trial Support: Bayer [Stroke]; Daiichi-Sankyo [Stroke]. All of the relevant financial relationships listed have been mitigated. Patr cia Canh o, MD, PhD No relevant financial relationship(s) with ineligible companies to disclose. Scott E Kasner, MD Grant/Research/Clinical Trial Support: Bayer [Stroke]; Bristol Meyers Squibb [Stroke]; Medtronic [Stroke]; WL Gore and Associates [Stroke]. Consultant/Advisory Boards: Abbvie [Stroke]; AstraZeneca [Stroke]; BMS [Stroke]; Diamedica [Stroke]; Medtronic [Stroke]. All of the relevant financial relationships listed have been mitigated. Douglas R Nordli, Jr, MD No relevant financial relationship(s) with ineligible companies to disclose. Richard P Goddeau, Jr, DO, FAHA No relevant financial relationship(s) with ineligible companies to disclose. Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence. Conflict of interest policy https://www.uptodate.com/contents/cerebral-venous-thrombosis-treatment-and-prognosis/print 33/33