Cerebral venous sinus thrombosis historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2] Sharmi Biswas, M.B.B.S

Overview

Cerebral venous sinus thrombosis (CVT) as first described by a French physician Ribes in 1825. But till the second half of 20th century, CVT was a diagnosis after death as it was frequently misdiagnosed due to overlapping of clinical symptoms and physical findings overlapping with other strokes. In 1951, introduction of venography made a drastic change in diagnosis of CVT.

Historical Perspective

A French physician named Ribes is the first one to report a case of cerebral vein thrombosis(CVT) in a 45 years old woman who presented with headaches and seizures. Autopsy findings revealed that there were superior sagittal sinus and lateral sinus thrombosis causing the symptoms. This is the first case report defining the features of cerebral vein thrombosis. The relationship between cerebral vein thrombosis and pregnancy was revealed a few years later when John Abercrombie, physician to King George IV, reported a case of a 24years old female who died 2 weeks after delivery due to status epilepticus and her autopsy showed thrombosis in superior sagittal sinus and cortical veins. In the second half of the 20th century, the introduction of catheter cerebral angiography helped to conduct larger clinical studies and more information about clinical characteristics, risk factors of CVT has been available..Dr.Charles Symonds in 1940 explained the clinical diagnosis of CVT using clinical signs, symptoms, and lumbar puncture results. In 1951, the introduction of venography brought a drastic improvement in diagnosing CVTwhich also aided in the distinction from idiopathic intracranial hypertension, which has similar presenting signs and symptoms in many cases.

In 1942, a British gynecologist Stansfield started using anticoagulant heparin to treat CVT. Clinical trials in the 1990s finally resolved the concern about using anticoagulants in most cases of cerebral venous sinus thrombosis. Early non-invasive diagnosis of CVT became easier with the widespread availability of CT with venography and MRI with venography in late 1980.