Hillary Clinton being treated for transverse sinus venous thrombosis

1.   Cerebral (brain) venous thrombosis is uncommon occurring in 1/lac population

2.   It is more common in neonates and children than in adults. In adults it is more common in women than men.

3.   The mean age of onset is 39 years old.

4.   Thrombosis of cerebral veins or dural sinus leads to increased venous and capillary pressure, which in turn leads to brain swelling, venous hemorrhage, and/or ischemia with cytotoxic edema.

5.   Occlusion of dural sinus causes decreased brain cerebrospinal fluid absorption and elevated brain pressure.

6.   Risk factors are hypercoagulable states, oral contraceptives, pregnancy, cancer, infection and head injury.

7.   The onset can be acute, subacute, or chronic.

8.   Headache is the most frequent symptom, occurring in 90% cases

9.   Other symptoms are focal neurologic deficits, focal or generalized fits, altered mental status, stupor, or coma.

10.       Brain MRI with MR venography is diagnostic

11.       Head CT scan is normal in up to 30 percent of  cases

12.             CT venography is a useful alternative to MR venography.

13.       There is complete recovery in 80 percent of patients.

14.       5% die in acute illness and 10% die over a period of time

15.       The main cause of acute death is brain herniation.

16.       Recurrence rate is 2 to 4 percent.

17.            Treatment is blood thinners initially with subcutaneous low molecular weight heparin or intravenous heparin followed with oral warfarin for 3-12 months