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Introduction: Few clinical features have been associated with delayed diagnosis of cerebral venous thrombosis with variable impact of delay on patient outcomes. We therefore sought to use the data from a recent, multicenter study ACTION-CVT (Anticoagulation in the Treatment of CVT) to identify factors associated with delayed CVT diagnosis and evaluate the effect of delay on functional outcome. Methods: All ACTION-CVT patients with available data on date of neurological symptom onset and date of CVT diagnosis were included. Delayed diagnosis of CVT was defined as diagnosis occurring in the fourth (final) quartile of days from symptom onset. We also report the proportion of patients who were discharged from hospital or ED within 3 months prior to index CVT admission for any neurological symptom without being diagnosed with CVT. The primary study outcome was an excellent functional outcome at 90 days defined as modified Rankin Scale (mRS) ≤1. Secondary outcome was partial or complete CVT recanalization on last available venous imaging. Chi-squared and Student’s t-tests were used to identify variables associated with delayed diagnosis. Logistic regression was used to identify independent predictors of delayed diagnosis in CVT as well as the association of delay with outcomes. Results: We included 935 CVT patients in our analysis. Median time from symptom onset to diagnosis was 4 days (IQR: 1-10). Delayed CVT diagnosis occurred in 212 (23%) patients (median time to diagnosis >10 days). Out of 212 patients with delayed CVT diagnosis, 64 (30.2%) patients were discharged from hospital/ED in the 3 months prior to their index CVT admission. Headache symptoms were a predictor of delayed diagnosis (OR: 2.36 [1.26-4.42]; p Conclusion: In a large, multicenter cohort we found that CVT patients presenting with headache were at increased risk of delayed diagnosis, however, delayed diagnosis was not associated with adverse outcomes. CVT diagnosis should be considered in patients presenting with a new headache.