Open research questions in Cerebral Venous Sinus Thrombosis

What the literature leaves open

• These findings support further study of venous sinus morphology as a potential contributor to MRI-visible PVS burden, while longitudinal and flow-sensitive studies are needed to clarify causality and glymphatic clearance mechanisms.

  A Quantitative Assessment of MRI-Visible Perivascular-Space Burden Across the Cognitive Spectrum: Associations with APOE ε4 Status and Venous Sinus Volume · 2026 · DOI

• Background: Idiopathic intracranial hypertension without papilledema (IIHWOP) is increasingly recognized, but its clinical characteristics and treatment-related outcomes remain insufficiently defined.

  Idiopathic Intracranial Hypertension with and Without Papilledema: A Comparative Cohort Study · 2026 · DOI

• To our knowledge, this represents the first report of off-label NeVa stent retriever use for thrombectomy in the cerebral venous system; the device's higher mesh density may theoretically offer advantages for organized venous thrombi in large-caliber sinuses, expanding therapeutic options where consensus on optimal technique remains elusive.

  Case Report: Mechanical thrombectomy of cerebral venous sinuses using the NeVa stent retriever · 2026 · DOI

• Cerebral venous sinus thrombosis (CVST) accounts for less than 1% of cerebrovascular events worldwide and is associated with significant morbidity; in severe or anticoagulation-refractory cases, mechanical thrombectomy is considered, yet no consensus exists on optimal device selection.

  Case Report: Mechanical thrombectomy of cerebral venous sinuses using the NeVa stent retriever · 2026 · DOI

• Based on our limited data (only 3 patients with subsequent pregnancies and no recurrences), as well as previous studies report- ing a low recurrence rate with appropriate prophylaxis, a prior his- tory of CVST may not be an absolute contraindication to pregnancy. Whether the ongoing pregnancy itself—through hormonal, hemodynamic, or immunological mechanisms—is associated with more rapid disease progression and an elevated risk of hemorrhagic transformation remains an unresolved question warranting further investigation.

  The hidden dangers of cerebral venous sinus thrombosis: insights into maternal morbidity and mortality during pregnancy · 2026 · DOI

• Advanced thrombophilia testing, including genet- ic analysis for factor V Leiden and prothrombin gene mutations, was not performed because of limited availability. Toxicological identification of the scorpi- on species was also not possible. cONcLUSION Ischemic stroke is a rare but important complica- tion of scorpion envenomation. Venom-induced au- tonomic dysregulation, endothelial injury, inflamma- tory activation, and prothrombotic mechanisms may collectively contribute to cerebrovascular thrombo- sis.

  Ischemic stroke as a rare complication of scorpion envenomation: a case report · 2026 · DOI

• A few limitations were identified in this study, this study relied on contrast-enhanced MRIs obtained from a single private radiological centre, therefore the findings may not represent the broader population. A small sample size which limited the detection of less common anatomical variations and restricted the evaluation of age-group comparisons. The classification of IVVs and IHVs, as well as the deter- mination of venous dominance, was based on MRI inter- pretation, which has limitations in depicting small venous tributaries; therefore, when a vein appeared absent, domi- nance may have been assigned even though the absence could reflect imaging limitations rather than true anatomical variation. Since this study did not utilise intraoperative or postoperative observations, the clinical impact of this study remains inferential.

  Anatomical investigation of the superficial venous drainage of the suboccipital surface of the cerebellum · 2026 · DOI

• Several limitations should be considered when interpreting the findings of this study. First, the retrospective cross-sectional design precludes assessment of causal relationships between visceral adiposity and intracranial hypertension. It remains uncertain whether visceral adiposity contributes directly to intracranial pressure dysregulation or represents a coexisting metabolic phenotype associated with radiological manifestations. Accordingly, the findings should be interpreted as associative rather than causative, and mechanistic inferences remain speculative. Second, lumbar puncture cerebrospinal fluid opening pressure measurements were not available for all participants. The study therefore relied primarily on radiological markers suggestive of intracranial hypertension rather than uniform physiological confirmation. Although these imaging features are widely recognized indicators of elevated intracranial pressure, the absence of standardized opening pressure measurements limits diagnostic certainty. In addition, detailed ophthalmologic assessment, including papilledema grading and visual field evaluation, as well as comprehensive clinical symptom documentation, was not consistently available. This limits clinicoradiological correlation and prevents full characterization of participants using established diagnostic frameworks. The cohort was therefore defined based on radiological features suggestive of intracranial hypertension rather than confirmed idiopathic intracranial hypertension, and findings should be interpreted accordingly. Third, the composite MRI severity score used in this study was developed for exploratory radiological assessment and has not undergone formal internal or external validation. The composite MRI severity score should therefore be interpreted as an exploratory radiological severity measure rather than a validated diagnostic instrument. MRI markers were assessed qualitatively as binary variables rather than using quantitative grading systems, which may limit sensitivity to subtle imaging variation. Ventricular prominence was evaluated separately but was not incorporated into the composite MRI severity score or subsequent correlation analyses because of its relatively nonspecific nature, lower prevalence, and limited discriminatory contribution within the study cohort. Although interobserver agreement for MRI interpretation demonstrated substantial-to-excellent reproducibility, some variability in qualitative neuroimaging assessment may still persist. Formal calibration testing beyond the Hosmer–Lemeshow statistic was not performed, and model adequacy was assessed primarily using standard goodness-of-fit and influence diagnostics.

  Beyond BMI: visceral adiposity and the neuroimaging phenotype of radiological intracranial hypertension · 2026 · DOI

• The Increased plasma OX-LDL levels observed in AMD patients may provide further support for this hypothesis[25], though direct confirmation in human ocular tissue is currently lacking.

  Systemic lipid abnormalities and choriocapillaris flow deficits in patients with hard drusen · 2026 · DOI

• In this study, we evaluated the thickness of the retinal layers above PHOMS as a quantifiable OCT-derived parameter for distinguishing true papilloedema from pseudo-papilloedema in patients with well-defined PHOMS. The method is simple, widely applicable and provides complementary information to existing methods, such as ppRNFL assessment alone. In patients with suspected optic disc oedema from raised ICP, a PHOMS UP thickness exceeding 300 µm points in the direction of true papilloedema and may reduce its overdiagnosis. SUMMARY What is known about this topic ● Differentiating pseudo-papilloedema from true papilloedema is crucial as the latter can be both vision and life-threatening. ● Optic Coherence Tomography (OCT) can visualise structural changes of the optic nerve head (ONH) but lacks the ability to differentiate between the two conditions. ● Peripapillary Hyperreflective Ovoid Mass-like Structures (PHOMS) are novel findings on OCT found in both pseudo- and true papilloedema, limiting their diagnostic specificity.

  Optical coherence tomography measurement of retinal layers above the peripapillary hyperreflective ovoid mass-like structure in true papilloedema and pseudo-papilloedema · 2026 · DOI

• Key strengths include the large sample size, double-centre design and involvement of two experienced neuro-ophthalmologists (SH, JAF) and an expert OCT grader (CMB). Several limitations should be acknowledged. Importantly, this study represents a highly selected cohort, as inclusion was restricted to patients with well-defined and sufficiently extensive PHOMS in exclusively young adults. These criteria were predefined to enable assessment of PHOMS-related mass effect on the overlying retinal layers, but resulted in the exclusion of a substantial proportion of screened patients. Notably, in the pseudo-papilloedema cohort, many excluded patients were screened out prior to OCT assessment, primarily due to age outside the predefined range of 18–45 years. In addition, the predefined PHOMS size criteria required medium to large PHOMS, thereby excluding small PHOMS and potentially underrepresenting early or mild papilloedema. Indeed, only a small proportion of included papilloedema cases were Frisén grade 1. Consequently, the findings may not be generalisable to patients with small PHOMS, subtle or early papilloedema, mixed phenotypes (such as coexisting optic disc tilt and papilloedema) and are not applicable to eyes without PHOMS. Furthermore, the true papilloedema cohort consisted exclusively of patients with IIH. Whether PHOMS UP measurements perform similarly in papilloedema caused by other aetiologies, such as intracranial tumours or other causes of raised intracranial pressure, remains to be determined. Interobserver variability was not formally assessed, as OCT images could not be transferred between sites. However, all measurements were performed according to a predefined standardised protocol and the low SDs relative to means (Table 1) indicate low variability, consistent with the high specificity of PHOMS UP thickness (Table 3).

  Optical coherence tomography measurement of retinal layers above the peripapillary hyperreflective ovoid mass-like structure in true papilloedema and pseudo-papilloedema · 2026 · DOI

• External gen- eralizability to other scanners, sequences, and case mixes therefore remains to be established. Consequently, a biologically grounded prepubertal-versus- postpubertal subgroup analysis could not be performed, and whether performance differs across pediatric age strata remains unknown.

  Diagnostic value of machine-learning using conventional magnetic resonance imaging markers for pediatric idiopathic intracranial hypertension: a retrospective study · 2026 · DOI

• Due to heterogenous classification and poorly understood pathomechanism there are no estimated prevalence and treatment guidelines for PACNS in pediatric population.

  Acute ischemic stroke secondary to childhood primary angiitis of cerebral nervous system (cPACNS) - case report and literature review · 2020 · DOI

• W części II i III opisano standardy dotyczące poszczególnych sytuacji klinicznych (skurcz naczyniowy, monitorowanie ostrego okresu udaru mózgu, wykrywanie bezpośredniego przecieku z krążenia małego – prawego do dużego – lewego, potwierdzanie zatrzymania krążenia mózgowego, ocena wydolności koła tętniczego mózgu, badanie rezerwy wazomotorycznej naczyń mózgowych i badanie hiperechogeniczności istoty czarnej).

  Standardy badań ultrasonograficznych. Neurosonologia. Część III · 2016 · DOI

• This study was limited in that the study size was small, it did not control for known risk factors such as sex and age, it did not include patients undergoing diagnostic LPs, and it did not investigate or correlate the quantity of daily caffeine intake before the LP was performed.

  Myth: Fluids, bed rest, and caffeine are effective in preventing and treating patients with post-lumbar puncture headache · 2002 · DOI

• The formulation of the first diagnosis was challenging due to the lack of diag- nostic measurements, the rare condition, and limited information about the patient’s clinical course.

  Misdiagnoses of Intracranial Hypotension: A Systematic Literature Review and Case Report · 2026 · DOI

• The formulation of the first diagnosis was challenging due to the lack of diag- nostic measurements, the rare condition, and limited information about the patient’s clinical course.

  Misdiagnoses of Intracranial Hypotension: A Systematic Literature Review and Case Report · 2026 · DOI

• Hence flow diverter coatings should be further investigated for added benefit in patients with higher baseline platelet reactivity or with increased perioperative thrombogenicity (i.

  Pilot feasibility study of intraprocedural transcranial Doppler monitoring to assess Heal coating thrombogenicity in flow diversion · 2026 · DOI

• W części I omówiono standardy wykonania, dokumentacji i opisu badań poszczególnymi metodami ultrasonograficznymi (badanie dupleksowe, badanie dopplerowskie).

  Standardy badań ultrasonograficznych. Neurosonologia. Część III · 2016 · DOI

• The exact incidence in neonates remains unknown and is likely to be underestimated, as clinical presentation is nonspecific and diagnosis can only be made when dedicated neuroimaging techniques, including computed tomographic venography or magnetic resonance venography, are performed.

  Neonatal Cerebral Sinovenous Thrombosis · 2011 · DOI

• Many of these are implemented routinely in daily practice—including increased fluids, bed rest, and caffeine—despite the lack of evidence of their effectiveness.

  Myth: Fluids, bed rest, and caffeine are effective in preventing and treating patients with post-lumbar puncture headache · 2002 · DOI

Most-cited papers in Cerebral Venous Sinus Thrombosis

• A Prospective Outcome Study of Neonatal Cerebral Sinovenous Thrombosis · Journal of Child Neurology · 2011 · 100 citations
• Neonatal Cerebral Sinovenous Thrombosis · Journal of Child Neurology · 2011 · 70 citations
• Idiopathic Intracranial Hypertension in Children · Journal of Child Neurology · 2000 · 55 citations
• Myth: Fluids, bed rest, and caffeine are effective in preventing and treating patients with post-lumbar puncture headache · Western Journal of Medicine · 2002 · 32 citations
• The Vienna idiopathic intracranial hypertension database—An Austrian registry · Wiener klinische Wochenschrift · 2023 · 18 citations
• Contrast Medium-Induced Encephalopathy after Coronary Angiography– Case Report · ˜The œJournal of Critical Care Medicine · 2021 · 12 citations
• Evaluation of the validity of mental foramen USG measurements by comparison with CBCT and determination of blood flow · Oral Radiology · 2023 · 5 citations
• Clinical Comparison of Patients with Angiography · Nigerian Journal of Clinical Practice · 2021 · 5 citations
• Canine Intracranial Venous System: A Review · Folia veterinaria · 2022 · 4 citations
• Patent Foramen Ovale: A Practical and Imaging Based Morphological Classification · e-Journal of Cardiovascular Medicine · 2022 · 4 citations

Most recent work

• Venous sinus stent placement is associated with improvement in volumetric skull base thickness · Journal of NeuroInterventional Surgery · 2026
• Cerebral venous sinus thrombosis risk across various oral contraceptives: a disproportionality analysis of the FDA adverse event reporting system · Journal of Neurology · 2026
• Integrative Management of Chronic Cerebral Venous Sinus Thrombosis with Ayurveda and Physiotherapy: A Case Report · JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · 2026
• Hyperhomocysteinemia as a risk factor for cerebral venous thrombosis: a systematic review and meta-analysis of the case–control studies · Annals of Medicine & Surgery · 2026
• Are there disparities in cerebral sinus venous thrombosis between the Arab and Jewish populations in Israel - a multicenter cohort study? · Journal of the Neurological Sciences · 2026
• Morphological variations of the dural venous sinuses: a cadaveric study · Frontiers in Surgery · 2026
• Cerebral venous sinus thrombosis secondary to nasopharyngeal abscess with Klebsiella pneumoniae infection in an elderly patient with multiple comorbidities: a case report and literature review · BMC Infectious Diseases · 2026
• Optical coherence tomography measurement of retinal layers above the peripapillary hyperreflective ovoid mass-like structure in true papilloedema and pseudo-papilloedema · Eye · 2026
• What imaging techniques are most effective in differentiating pseudopapilledema from papilledema caused by increased intracranial pressure? · Open MIND · 2026
• Diagnostic value of machine-learning using conventional magnetic resonance imaging markers for pediatric idiopathic intracranial hypertension: a retrospective study · Pediatric Radiology · 2026

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