What are the key clinical features that should raise suspicion for cerebral venous sinus thrombosis (CVST) in a primary care setting?

Key clinical features that should raise suspicion for cerebral venous sinus thrombosis (CVST) in a primary care setting include:

• New onset headache that is often progressive, severe, and may be different from previous headaches or migraines, as headache is the most common presenting symptom NICE NG158 Idiculla et al. 2020.
• Focal neurological deficits such as weakness, sensory disturbances, or cranial nerve palsies, which may develop due to venous infarction or raised intracranial pressure NICE NG158 Idiculla et al. 2020.
• Seizures, which can be focal or generalized, are a notable feature and may be the initial presentation NICE NG158 Idiculla et al. 2020.
• Signs of raised intracranial pressure including papilloedema, nausea, vomiting, and visual disturbances, reflecting impaired venous drainage and increased intracranial pressure NICE NG158 Idiculla et al. 2020.
• Altered mental status or reduced consciousness in more severe cases, indicating extensive thrombosis or secondary complications NICE NG158 Idiculla et al. 2020.
• Risk factors or predisposing conditions such as recent pregnancy or puerperium, oral contraceptive use, thrombophilia, infection, malignancy, or dehydration should heighten clinical suspicion NICE NG158 Idiculla et al. 2020.

In primary care, the combination of a new, unusual headache with any focal neurological signs, seizures, or symptoms/signs of raised intracranial pressure, especially in the presence of relevant risk factors, should prompt urgent referral for neuroimaging to exclude CVST NICE NG158. Early recognition is critical due to the potential for rapid deterioration and the need for anticoagulation treatment Idiculla et al. 2020.