Cerebral venous thrombosis: imaging patterns

Oliveira, Isabela Magalhães; Duarte, Juliana Ávila; Dalaqua, Mariana; Jarry, Vinícius de Menezes; Pereira, Fernanda Veloso; Reis, Fabiano

doi:10.1590/0100-3984.2021.0019

Cited by 13 publications

(8 citation statements)

References 14 publications

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“… 26 One can use a contrast agent or not when doing the MR venography modality. 27 Time-resolved contrast-enhanced MR venography has very superior accuracy which relies on luminal filling by contrast material rather than MR flow phenomena when utilizing the time-of-fight method. 27 …”

Section: Discussionmentioning

confidence: 99%

Progressive Cerebral Venous Thrombosis with Cranial Nerve Palsies in an Adolescent African Girl & Associated Diagnostic Pitfalls: A Rare Case Report

Asfaw

Huang

Taimur

et al. 2023

IMCRJ

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Cerebral venous thrombosis (CVT) is a cerebrovascular disorder caused by complete or partial occlusion of the cerebral venous and sinus system. The etiology has been attributed to hypercoagulability and pro-thrombotic states, leading to raised intracranial pressures that often manifest as headaches and focal neurological deficits. However, the multifactorial nature of CVT can create a diagnostic conundrum for clinicians. We describe a unique case of a 16-year-old female who presented with convulsions, postictal confusion, and drowsiness followed by residual weakness of her extremities. She initially presented to the primary care center with headache, high-grade fever, and altered mental status and was empirically treated for pyogenic meningitis. The patient failed to improve with a week of antibiotics and was referred to the tertiary care center for urgent attention. On presentation, the patient developed VI and VII cranial nerve palsy. Subsequently, MRI images showed filling defects in the superior sagittal, right transverse, and sigmoid sinuses with right parietal gyral T1 hyperintensity and T2 hypo-intensity. She was diagnosed with septic CVT based on sinus venous thrombosis and venous infarction, probably secondary to meningococcal pneumonia. It can be challenging to distinguish between both conditions as their presentations overlap. Moreover, cranial nerve palsy is an infrequent manifestation of CVT, with unclear pathogenesis. We highlight the role of neuro-imaging in the early detection of CVT and bring to light the unfamiliar symptoms and a more varied clinical spectrum that may hinder the diagnosis in a limited-resource setting. Future research should be explicitly modeled to improve the diagnostic efficiency of CVT and improve outcomes in younger patient populations.

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Section: Discussionmentioning

confidence: 99%

Progressive Cerebral Venous Thrombosis with Cranial Nerve Palsies in an Adolescent African Girl & Associated Diagnostic Pitfalls: A Rare Case Report

Asfaw

Huang

Taimur

et al. 2023

IMCRJ

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“…Neuroimaging is therefore essential for the diagnosis of CVT. 34 CVT patients were enrolled in this investigation after neuroimaging confirmation using either magnetic resonance venography, computed tomography venography, magnetic resonance black-blood imaging, or digital subtraction angiography.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Clinical-Based Severity Scale for Patients with Cerebral Venous Thrombosis

Li,

Wan,

Wang

et al. 2023

IJGM

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Introduction Cerebral venous thrombosis (CVT) is a rare subtype of stroke. However, existing scales were insufficient to evaluate the overall severity of CVT. The aim of this study is to develop and validate a CVT severity scale. Methods Items 1–11 were directly derived from NIHSS. New items were generated from a literature review and focus group discussion. A total of 170 CVT patients were prospectively recruited from 26 top tertiary hospitals in China Mainland from January 2021 to May 2022 to validate the CVT severity scale. The CVT severity scale, NIHSS, mRS and GCS were rated at admission. The lumbar puncture opening pressure was also recorded. Twenty randomly selected CVT patients were rated with the CVT severity scale again 24 hours later. The clinical outcome of CVT was evaluated by mRS at 6 months after baseline. Results We successfully established a CVT severity scale with 18 items. Exploratory factor analysis showed that 18 items were attributed to factor 1 (focal neurological deficits), factor 2 (diffuse encephalopathy), factor 3 (intracranial hypertension) and factor 4 (cavernous sinus syndrome). CVT severity scale was positively correlated with ICP, NIHSS and mRS, and negatively correlated with GCS at baseline. CVT severity scale >3 or factor 3 >2 indicated intracranial hypertension. CVT severity scale >10 indicated poor clinical outcome at 6 months of follow-up. Meanwhile, CVT severity scale showed high internal consistency and test–retest reliability. Conclusion The CVT severity scale included 18 items encompassing 4 domains of focal neurological deficits, diffuse encephalopathy, IH and cavernous sinus syndrome. CVT severity scale correlated well with ICP, NIHSS, mRS and GCS. Patients with CVT severity scale >10 can be defined as severe CVT. The CVT severity scale may serve as a valid and reliable tool for measuring the overall severity of CVT.

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“…In cases of CVT, contrast-enhanced MR venography provides detailed visualization of thrombosed segments within the venous sinus, showing strong correlation with conventional digital subtraction angiography (DSA) findings and distinguishing anatomical variations, such as hypoplastic sinuses, from CVT. CVT, which is defined as a thrombus in a venous sinus, superficial intracranial vein, or deep intracranial vein ( Oliveira et al, 2022 ) can also be visualized on MRI. This is due to the fact that patent dural sinuses typically appear as a flow void – a signal loss that occurs within moving fluids.…”

Section: Role Of Mri In Identifying An Ich Etiologymentioning

confidence: 99%

Neuro-imaging in intracerebral hemorrhage: updates and knowledge gaps

Penckofer,

Kazmi,

Thon

et al. 2024

Front. Neurosci.

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Intracerebral hemorrhage (ICH) is characterized by hematoma development within the brain’s parenchyma, contributing significantly to the burden of stroke. While non-contrast head computed tomography (CT) remains the gold standard for initial diagnosis, this review underscores the pivotal role of magnetic resonance imaging (MRI) in ICH management. Beyond diagnosis, MRI offers invaluable insights into ICH etiology, prognosis, and treatment. Utilizing echo-planar gradient-echo or susceptibility-weighted sequences, MRI demonstrates exceptional sensitivity and specificity in identifying ICH, aiding in differentiation of primary and secondary causes. Moreover, MRI facilitates assessment of hemorrhage age, recognition of secondary lesions, and evaluation of perihematomal edema progression, thus guiding tailored therapeutic strategies. This comprehensive review discusses the multifaceted utility of MRI in ICH management, highlighting its indispensable role in enhancing diagnostic accuracy as well as aiding in prognostication. As MRI continues to evolve as a cornerstone of ICH assessment, future research should explore its nuanced applications in personalized care paradigms.

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Cerebral venous thrombosis: imaging patterns

Cited by 13 publications

References 14 publications

Progressive Cerebral Venous Thrombosis with Cranial Nerve Palsies in an Adolescent African Girl & Associated Diagnostic Pitfalls: A Rare Case Report

Progressive Cerebral Venous Thrombosis with Cranial Nerve Palsies in an Adolescent African Girl & Associated Diagnostic Pitfalls: A Rare Case Report

Development and Validation of a Clinical-Based Severity Scale for Patients with Cerebral Venous Thrombosis

Neuro-imaging in intracerebral hemorrhage: updates and knowledge gaps

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