Cerebral Sinovenous Thrombosis

Abstract

<jats:p> Cerebral sinovenous thrombosis (CSVT) is an uncommon disorder that affects the dural venous sinus and cerebral vein. In our study, thirty-four patients were examined. Pre and/or post contrast-enhanced CT was done in 28 patients. MRI studies were done in 24 patients. 2-D TOF MR venography (MRV) and contrast-enhanced MRV (CEMRV) were done in 19 cases. Digital subtraction angiography (DSA) was done in 18 patients. Sixteen patients received systemic intravenous heparinization, and 12 received endovascular thrombolytic treatment with urokinase combined with anticoagulant therapy. </jats:p><jats:p> Neuroimages of CSVT can be acquired by direct visualization of the thrombus within the dural sinus or by parenchymal changes secondary to venous occlusion. As there are some pitfalls to MRI in the diagnosis of CSVT, the combination of MRI and MRV is now the gold standard in the diagnosis of CSVT. Usually, accuracy can be improved by applying 2-D TOF MRV and CE MRV. Furthermore, the source image of MRV is critical in differentiating between normal sinus variations and diseased ones. DSA is the best tool for demonstrating dynamic intracranial circulation in CSVT and mostly is used for endovascular treatment. </jats:p><jats:p> Systemic intravenous anticoagulant therapy with heparin is accepted as a first line treatment. Except for clinical manifestations after systemic heparinization, abnormal MR findings of parenchymal change can be used to determine when to initiate thrombolytic treatment. Endovascular therapy can be finished at the ante-grade flow within the dural sinus and continuous anticoagulation is sufficient to facilitate clinical improvement. </jats:p><jats:p> Clinical suspicion and excellent neuroimaging are crucial in making the diagnosis of CSVT. Proper management with anticoagulants and/or endovascular thrombolytic therapy is mandatory in preventing propagation of the thrombosis and improving the clinical outcome. </jats:p>

Cerebral sinus venous thrombosis

“…Overall, this sign has been reported in only 2% of CSVT cases;[ 80 ] and the “empty delta (or empty triangle) sign,” seen after the contrast medium is administered, has been reported in between 10% and 35% of cases;[ 80 ] it is produced due to an intraluminal filling defect surrounded by contrast in the posterior portion of the SSS;[ 5 ] there is enhancement in the wall of this sinus that is outlining the hypodense clot within the lumen. [ 80 ] The enhancement is occurring in collateral veins in the sinus wall surrounding the clot;[ 78 81 82 ] usually is associated to poor prognosis. This sign can be mimicked by many conditions like high splitting of the superior sagittal sinus, subdural hematoma, sub-arachnoid hemorrhage, epidural abscesses, and by the presence of fenestrations and septae within the sinus.…”

Thrombosis: A Laboratory Diagnosis of Cerebral Sinus Venosus Thrombosis (CSVT) with Cardiac Myxoma

“…Use of oral contraceptives (OC), pregnancy, childbirth, and hormone replacement therapy are risk factors associated with gender, except for children and elderly patients, this patient even if it is a woman, but elderly patients. [3,5,10] The risk factors underlying the occurrence of CSVT in these patients are probably due to the patient 83 years old, there is immobilization and myxoma in the left atrial based on the results Echocardiography on November 23 2017 which can cause flow obstruction blood, causing venous thrombosis. Based on the triad of Virchow's there are three factors that play a role, namely damage to the blood vessel wall, hypercoagulability and stasis.…”

Diagnostic and Therapeutic Challenges of Concurrent Intracranial Hemorrhage and Cerebral Venous Thrombosis in a Patient With Acute Lymphoblastic Leukemia: A Case Report and Literature Review

“…Dimensional time-of-flight magnetic resonance venography (MRV) has excellent sensitivity and is the most currently used method for the diagnosis ofCVST [1]. When using MRV, there is a direct sign of CVST demonstrated by high flow signal loss and fuzzy edges of a normally developed venous sinus or irregular lower blood flow signals [27,28]. Chronic thrombosed hypoplastic sinus presents with marked enhanced sinus and no flow on two-dimensional time-of-flight MRV, and contrast-enhanced MRI offers improved visualization of cerebral venous structures [1].…”