An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis (a Narrative Review)

Abstract

(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis.

Challenges in Cerebral Venous Thrombosis Management—Case Reports and Short Literature Review

“…In 30% of cases, the CT without enhancement can appear normal [ 17 ], as it was in one of the cases presented by us. DSA (digital subtraction angiography) has the highest diagnostic accuracy and is recommended when the basic techniques do not elucidate the diagnosis or when a dural fistula is suspected [ 3 ]. The ESO guidelines suggest MRI venography or CT venography to confirm the diagnosis of CVT.…”

“…A study from 2019 mentions the involvement of multiple venous sinuses in 76% of cases, with left heart attacks being twice as frequent as right ones (36% versus 18%) [ 18 ]. In the vast majority of people, the cerebral veins on the right side are dominant; hence, an obstruction of the right transverse sinus will have a greater clinical impact [ 3 ].…”

“…In 26% of patients, this can be the only manifestation of the onset of the disease, misguiding the diagnosis [ 2 ]. Sometimes the symptoms are complex and non-specific and further complicate the diagnosis which can be established using cerebral CT venography or MRI venography with contrast if MRI imaging is rapidly available [ 3 ].…”

Stick a Needle in My Eye: A Case Report of Penetrating Needlefish Injury Causing Cavernous Sinus Thrombosis and Carotid Cavernous Fistula

“…CT venogram (CTV) and contrast-enhanced MR venogram (MRV) are much more sensitive. MRV is the preferred diagnostic neuroimaging modality as it can demonstrate edema and venous infarction of the superficial and deep venous system of the brain parenchyma [ 12 ]. Interventional radiological methods such as direct cerebral venography may be necessary when MRV or CTV results are inconclusive, or if the patient requires an endovascular procedure [ 13 ].…”

Cerebral Sinus Vein Thrombosis and Gender: A Not Entirely Casual Relationship

“…However, the rare episodes of CSVT are not significantly associated with the presence of these antibodies but it is hypothesized that these manifestations may be linked to an immune-mediated nervous impairment [96]. Analyzing all the cases reported in the literature, it is possible to speculate that CSVT during SS completely favors the female sex and therefore it would seem that this is the only variable that, together with the neurological manifestations, can guide in the diagnosis of this complication [96][97][98][99].…”