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. 2002 Mar 30;8(1):5-14.
doi: 10.1177/159101990200800102. Epub 2004 Oct 20.

Clinical Presentation, Imaging and Treatment of Cerebral Venous Thrombosis (CVT)

S K Lee  1 , B S Kim, K G Terbrugge
Affiliations

Clinical Presentation, Imaging and Treatment of Cerebral Venous Thrombosis (CVT)

S K Lee et al. Interv Neuroradiol. .
No abstract available

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Figures

Figure 1
Figure 1
A 32-year-old woman developed generalized seizure at postpartum 2 weeks. Initial non-enhanced brain CT (A) reveals focal right parietal intracranial hemorrhage. T2 weighted axial MR image (B) shows right parietal subacute hematoma and MR venogram (C) does not demonstrate dural sinus occlusion. Because there was no radiologic evidence of CVT, the patient was not given any treatment for 1 week. Follow-up non-enhanced CT (D) shows bilateral intracerebral hemorrhage, dense superior sagittal sinus and subdural fluid collections. MRV (E) demonstrates total occlusion of the superior sagittal sinus. Partial occlusion of distal straight sinus and mid-portion of right transverse sinus are also revealed. Retrograde evaluation of initial MRI (T2 weighted coronal) (F) and MRV source image (G) shows right parietal cortical vein thrombosis without dural sinus involvement. On T2 weighted coronal image (F), thrombosed cortical vein (arrow) shows low signal intensity, so it is difficult to differentiate it from normal vascular signal voids. However, on MRV source image (G), it turns to high signal intensity (arrow) suggesting acute thrombosed cortical vein.
Figure 1
Figure 1
A 32-year-old woman developed generalized seizure at postpartum 2 weeks. Initial non-enhanced brain CT (A) reveals focal right parietal intracranial hemorrhage. T2 weighted axial MR image (B) shows right parietal subacute hematoma and MR venogram (C) does not demonstrate dural sinus occlusion. Because there was no radiologic evidence of CVT, the patient was not given any treatment for 1 week. Follow-up non-enhanced CT (D) shows bilateral intracerebral hemorrhage, dense superior sagittal sinus and subdural fluid collections. MRV (E) demonstrates total occlusion of the superior sagittal sinus. Partial occlusion of distal straight sinus and mid-portion of right transverse sinus are also revealed. Retrograde evaluation of initial MRI (T2 weighted coronal) (F) and MRV source image (G) shows right parietal cortical vein thrombosis without dural sinus involvement. On T2 weighted coronal image (F), thrombosed cortical vein (arrow) shows low signal intensity, so it is difficult to differentiate it from normal vascular signal voids. However, on MRV source image (G), it turns to high signal intensity (arrow) suggesting acute thrombosed cortical vein.
Figure 2
Figure 2
A 62-year-old woman with acute lymphocytic leukemia was treated with heparin due to dural sinus thrombosis. However, the patient's consciousness level deteriorated despite anticoagulation (INR=1.28). Initial non-enhanced CT (A) shows subtle increased attenuation (arrow) on right temporal lobe and right transverse sinus suggesting parenchymal hemorrhage and dural sinus thrombosis, respectively. T2 (B) weighted axial MR demonstrate sulcal effacement and acute parenchymal hemorrhage (arrow) on right temporal lobe. MR venography (C) and venous phase of right internal carotid angiogram (D) reveal nonvisualization of proximal to mid portion of superior sagittal sinus (SSS) and straight sinus. Note there is a lack of parenchymal staining on occipital and temporal lobes on right internal carotid angiogram. Superselective SSS angiography (E) show multifocal filling defects suggesting sinus thrombosis. After infusion of 30mg of t-PA, right internal carotid angiography (F) demonstrates complete re-canalization of SSS and partial recanalization of straight sinus. Three months follow-up MR venography (G) shows patent SSS and straight sinus.
Figure 2
Figure 2
A 62-year-old woman with acute lymphocytic leukemia was treated with heparin due to dural sinus thrombosis. However, the patient's consciousness level deteriorated despite anticoagulation (INR=1.28). Initial non-enhanced CT (A) shows subtle increased attenuation (arrow) on right temporal lobe and right transverse sinus suggesting parenchymal hemorrhage and dural sinus thrombosis, respectively. T2 (B) weighted axial MR demonstrate sulcal effacement and acute parenchymal hemorrhage (arrow) on right temporal lobe. MR venography (C) and venous phase of right internal carotid angiogram (D) reveal nonvisualization of proximal to mid portion of superior sagittal sinus (SSS) and straight sinus. Note there is a lack of parenchymal staining on occipital and temporal lobes on right internal carotid angiogram. Superselective SSS angiography (E) show multifocal filling defects suggesting sinus thrombosis. After infusion of 30mg of t-PA, right internal carotid angiography (F) demonstrates complete re-canalization of SSS and partial recanalization of straight sinus. Three months follow-up MR venography (G) shows patent SSS and straight sinus.
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