Chronic headache as a clinical manifestation of cerebral venous sinus thrombosis

Patients with cerebral venous thrombosis (CVT) pre-sent with a range of symptoms, which varies widely from headache to coma. Chronic occlusion of venous dural sinuses leads to the initiation of compensation processes, such as vascular collatera-lization, recanalization of the organized thrombus. Consequently, their efficacy determines disease course and severity. The purpose of our study was to highlight the clinical challenges while managing a patient with subcompensated CVT. Taking into account the fact that mild severity is observed in 20 % of cases, eventually, about a quarter of patients presenting with the headache of unclear etio-logy becomes unnoticed and results in low quality of life. To analyze the disease outcome and prognosis, we accurately studied compensation mechanisms, which occur in a patient due to cerebral venous sinus thrombosis, notably venous collateral circulation and thrombus recanalization. However, the most important “pitfall” of chronic dural sinuses occlusion, when not appropriately treated, is the fact that hemodynamic compensation also leads to a high risk of cerebrovascular events, which may lead to death or disabi-lity. The patient with cerebral venous thrombosis of the transverse and sigmoid sinuses manifested migraine-like headache with a vegetative issue and signs of increased intracranial pressure. Due to the absence of anticoagulant therapy, venous drainage through collateral pathways and recanalization of thrombosed sinuses were insufficient to maintain a cerebral blood supply, resulting in diffuse cerebral edema, secondary brain injury. After an accurate survey, diagnostic procedures, prescribing of individualized treatment, and long-term follow-up with correction of therapy the patient experienced regression of CVT symptoms. Cerebral MRI venography is an important tool for the diagnosis and prediction of the prognosis of this condition. Thus, patients with a long history of untreatable headache and signs of intracranial hypertension should undergo this procedure. To consider intracranial vascular events and outcomes, the venous hemodynamics should be evaluated. Moreover, it is often necessary to examine cerebral veins and sinuses, when hemorrhagic stroke does not correspond to cerebral arterial territories and has unclear etiology.