A patient with worsening headache and confirmed cerebral venous sinus thrombosis on CT should have which of the following as the most appropriate management?

The management of cerebral venous sinus thrombosis (CVST) can indeed be complex, particularly in cases where the patient exhibits worsening symptoms like a severe headache. In this scenario, the correct choice involves considering a timely intervention if the patient’s condition is deteriorating.

Endovascular therapy is indicated for patients with progressive neurological deficits or those who have not responded to anticoagulation therapy alone. This is particularly true if there is evidence of ongoing thrombosis despite anticoagulation, which could lead to irreversible damage. In cases such as CVST, while anticoagulation remains the cornerstone of treatment, the need for more aggressive interventions, such as endovascular therapy, becomes crucial if there is clinical deterioration.

In contrast, other options may not be appropriate for worsening symptoms in this setting. For example, increasing heparin infusion without addressing the potential for more invasive intervention may not suffice, especially if the standard management is not leading to improvement. Adding argatroban or a glycoprotein IIb/IIIa inhibitor may not be the optimal course either, as these do not specifically target the management of CVST in the context indicated. Therefore, the most appropriate management in this scenario focuses on the need for potentially life-saving endovascular procedures to address the acute