Neurology: cerebral venous thrombosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: cerebral venous thrombosis

Sample item

A 26-year-old woman on an oral contraceptive has had a severe headache for a week, followed by a seizure. She has papilloedema, and CT shows a small parasagittal haemorrhagic infarct. MR venography shows superior sagittal sinus thrombosis. What is the most appropriate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Therapeutic low molecular weight heparin, followed by oral anticoagulation

Cerebral venous thrombosis is treated with anticoagulation, even when there is haemorrhagic venous infarction, because it prevents propagation and improves outcome. Heparin is followed by warfarin or a direct oral anticoagulant for at least three to twelve months, based on risk factors. Antiseizure drugs treat seizures and endovascular therapy is reserved for deterioration despite anticoagulation.

Option by option

  • A. Antiseizure drug alone, avoiding anticoagulation because of the haemorrhage

    Withholding anticoagulation allows the clot to extend and worsens venous congestion.

  • B. Intravenous alteplase

    Systemic thrombolysis risks bleeding into the infarct and is not first-line.

  • C. Therapeutic low molecular weight heparin, followed by oral anticoagulation (correct)

    Anticoagulation is standard care and haemorrhagic infarction is not a contraindication in venous thrombosis.

  • D. Acetazolamide with repeated lumbar punctures

    Acetazolamide and lumbar puncture lower pressure in idiopathic intracranial hypertension but do not treat the thrombus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Therapeutic low molecular weight heparin, followed by oral anticoagulation. Cerebral venous thrombosis is treated with anticoagulation, even when there is haemorrhagic venous infarction, because it prevents propagation and improves outcome.

Why is "Antiseizure drug alone, avoiding anticoagulation because of the haemo…" not the answer?

Withholding anticoagulation allows the clot to extend and worsens venous congestion.

Why is "Intravenous alteplase" not the answer?

Systemic thrombolysis risks bleeding into the infarct and is not first-line.

Why is "Acetazolamide with repeated lumbar punctures" not the answer?

Acetazolamide and lumbar puncture lower pressure in idiopathic intracranial hypertension but do not treat the thrombus.

What concept does this question test?

It tests Neurology: cerebral venous thrombosis in General Medicine. Heparin is followed by warfarin or a direct oral anticoagulant for at least three to twelve months, based on risk factors. Antiseizure drugs treat seizures and endovascular therapy is reserved for deterioration despite anticoagulation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: cerebral venous thrombosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.