Diagnosis, Treatment, and Prognosis of Cerebral Venous Thrombosis.

Abstract

Cerebral venous thrombosis (CVT) is an uncommon but potentially severe cerebrovascular disorder that predominantly affects young adults and women. Advances in neuroimaging have improved diagnostic accuracy and have enabled better characterization of clinically relevant phenotypes, including edema patterns, venous infarction, and hemorrhagic transformation, which may influence prognosis and therapeutic strategies. Anticoagulation remains the cornerstone of treatment across disease severities. Emerging evidence supports the use of direct oral anticoagulants as safe and effective alternatives to vitamin K antagonists in selected patients. The role of endovascular therapy remains limited to carefully selected cases with clinical deterioration, despite optimal medical therapy, while decompressive surgery may be lifesaving in severe CVT with large space-occupying lesions and risk of cerebral herniation. Improved recognition of systemic and local prothrombotic risk factors has refined secondary prevention strategies and highlights the need for individualized management. Long-term outcomes extend beyond functional recovery, with many patients experiencing persistent cognitive symptoms, fatigue, and reduced quality of life. Despite recent progress, important gaps remain, including optimal management of severe CVT and improved tools for early prognostic stratification integrating clinical, imaging, and biomarker data. Future research should focus on personalized management approaches and strategies to reduce global disparities in CVT care.