The true worldwide incidence is not known, but they are rarer than other types of stroke with a slight female preponderance, accounting for about 50% of strokes during pregnancy and puerperium. It is more common than previously thought. Increased frequency is being reported since advent of digital subtraction angiography (DSA), computerized tomography (CT) and magnetic resonance imaging (MRI). Inherited risk factors include protein C or S deficiency, antithrombin III deficiency, Factor V Leiden mutation (with activated protein C resistance), prothrombin gene mutation, paroxysmal nocturnal hemoglobinuria; hyperhomocysteinemia is a significant risk factor in India. Usually the onset of symptoms is gradual with headache, seizures and altered sensorium (in that order). Infarct at an unusual territory should alert the physician. The superior sagittal sinus is most commonly involved, followed by the transverse sinus, sigmoid and straight sinuses. Supportive management with IV fluids, anticonvulsants, and ICP control, as in acute arterial infarcts, is the mainstay; most of them recover with heparin in addition to supportive measures. Antiplatelet drugs have been advocated in CVT but have never been systematically studied. Endovascular techniques have a definite role in high-risk patients.