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Controversies in Neurology
July 2008

Cerebral Venous Sinus Thrombosis: To Treat or Not to Treat?

Arch Neurol. 2008;65(7):987-988. doi:10.1001/archneur.65.7.987

In the kingdom of the blind, the one-eyed man is king.—Desiderius Erasmus

If there were conclusive data showing an unequivocal benefit from the anticoagulation of individuals with cerebral venous sinus thrombosis (CVST), there should be little controversy about how to treat this condition. The problem is that the data favoring anticoagulation for CVST are very suggestive but not compelling, and some of us tend to be more skeptical than others. Based on the available studies, Stam1 argues strongly for anticoagulation in individuals with CVST. Wasay and Kamal,2 in contrast, believe that the evidence supporting anticoagulation for CVST is at best weak and that additional studies are needed. Wasay and Kamal2 also suggest that unquestioning acceptance of anticoagulation for CVST tends to limit consideration of other, potentially better, forms of therapy.

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