Diffusion-Weighted Magnetic Resonance Imaging in a Case of Cerebral Venous Thrombosis

Abstract

Background-Diffusion-weighted imaging (DWI) is the most sensitive MR sequence in acute arterial ischemic stroke buthas not yet been evaluated in venous cerebral ischemia. We describe a patient with DWI performed at the acute phase of a venous ischemic stroke. Case Description-A rapid cerebral MRI including DWI and fast fluid-attenuated inversion recovery (FLAIR) sequences was performed at the acute phase of a venous stroke confirmed by conventional angiography. DWI showed a slight decrease in apparent diffusion coefficient values 3 hours after onset (0.53Ϯ0.07ϫ10 Ϫ3 mm 2 /s) and was normal 48 hours later (0.064Ϯ0.15ϫ10Ϫ3 mm 2 /s). Fast FLAIR sequences showed large left frontoparietal hyperintensities. The lack of a clear decrease in apparent diffusion coefficient values associated with marked FLAIR abnormalities may suggest prominent or early associated vasogenic edema. Physiopathological differences between arterial and venous ischemia may explain the different type of DWI FLAIR abnormalities during the acute phase as well as the better recovery of neurological deficit in venous stroke than in arterial ischemic stroke. Conclusions-In the context of an acute stroke, the contrast between marked FLAIR and subtle DWI abnormalities on MRI may reflect the venous mechanism of cerebral ischemia.

Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging in Deep Cerebral Venous Thrombosis

“…When observed with DWI, the ADC values in vasogenic edema are increased, 8 as in our patient. A similar case was recently published by Corvol et al, 9 who found slight, reversible DWI and marked fluid-attenuated inversion recovery abnormalities in a patient with CVT of the superior sagittal sinus and flow reversal in the cortical veins. The findings were judged to be vasogenic edema; the patient recovered rapidly after treatment with intravenous heparin and had a complete normalization of ADC values.…”

“…The induced venous infarction was characterized by perfusion deficits and early cytotoxic edema (ADC declined to 56Ϯ7%) closely followed by vasogenic edema after blood-brain barrier disruption (ADC, 84Ϯ8% by 48 hours). This animal study proves that venous infarction with damage of neuronal tissue can be predicted by typical patterns in DWI and PI, which are known from arterial stroke and are more severe than in the case presented in this article and the case of Corvol et al 9 In conclusion, we believe that in addition to their use for evaluation of ischemic stroke after arterial vessel occlusion, DWI and PI can play a role in diagnosis of cerebral venous ischemia. The MR features presented in this case reflect the underlying pathophysiology of venous congestion with impaired but viable neuronal tissue.…”

Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

“…Diffusion weighted images may not offer information regarding the establishment of diagnosis but provide information on the pathophysiology of CVST. 14,15,49,72 Transcranial Doppler ultrasonography offers a noninvasive approach for diagnosis or follow-up of CVST, but the results are not sufficient for providing a valuable tool in the clinical setting.…”

Intracranial Dural Sinus Thrombosis: Novel Use of a Mechanical Thrombectomy Catheter and Review of Management Strategies

“…[38][39][40][41][42][43] In a review of cranial sinus thrombosis cases from 1942 to 1990, Diaz et al 43 showed this combination to be particularly lethal, resulting in a mortality rate of 95.6%. In these patients, pulmonary embolism appeared to be strongly suggestive of thrombus dislodgment from the cranial sinuses, particularly the superior sagittal sinus.…”