PATTERN OF MAGNETIC RESONANCE IMAGING AND MAGNETIC RESONANCE VENOGRAPHY CHANGES IN CEREBRAL VENOUS SINUS THROMBOSIS
AbstractBackground: Cerebral venous sinus thrombosis is a common but highly under-recognised condition,which is missed not only by general practitioners but also by neurologists. Computerised tomography(CT) or magnetic resonance imaging (MRI) of brain alone is not sufficient to diagnose this condition.Objective of this study was to explore the pattern of magnetic resonance imaging (MRI) and magneticresonance venography (MRV) changes in cerebral venous sinus thrombosis (CVST). Methods: Thiswas a descriptive study in which 52 cases of cerebral venous sinus thrombosis with special emphasis ontheir MRI and MRV findings were included. The study was conducted in Neurology Unit, LadyReading Hospital, Peshawar, Pakistan, from January 2010 to July 2011. All patients suffering fromcerebral venous sinus thrombosis were included in the study. Multi-planar/multi-sequential, Tesla 1.5MRI/MRV time of flight images were done in all cases where there was suspicion of cerebral venoussinus thrombosis. Results: Out of 52 patients with cerebral venous sinus thrombosis 41 (78.84%) werefemale and 11 (21.15%) were male. Mean age was 37±5 years. Definite risk factors were found in 38(73.076%) patients with pregnancy, use of oral contraceptives or puerperium being the most frequentlyfound risk factor in 20 (73.076%) patients. Most common complaint was headache found in 41(78.84%) patients, followed by focal neurological deficits, and altered mental status and seizures.Papilloedema was seen in 20 (38.46%) patients. The cerebral venous sinuses most frequently involvedwere transverse and sigmoid sinuses in 17 patients (32.69%) while superior sagittal sinus alone in 10(19.23%) patients. Overall CT brain was normal in 30% and MRI brain in 23.07% patients; however,MRV of these patients revealed CVST. Conclusion: Imaging plays a primary role in the diagnosis ofcerebral venous sinus thrombosis because the clinical picture of CVST is non-specific and highlyvariable. Thrombosis of cerebral venous system is readily picked-up on MRV even if it is missed byCT scan or MRI.Keywords: Cerebral venous sinus thrombosis, CVST, Magnetic Resonance Imaging, MRI, MagneticResonance Venography, MRV, Computed Tomography, CT
Filippidis A, Kapsalaki E, Patramani G, Fountas KN. Cerebral
venous sinus thrombosis: review of the demographics,
pathophysiology, current diagnosis and treatment. Neurosurg
Crassard I, Bousser MG. Cerebral venous thrombosis. Rev Med
Siddiqui FM, Kamal AK. Incidence and epidemiology of cerebral
venous thrombosis. J Pak Med Assoc 2006;56:485–7.
Kalita J, Bansal V, Misra UK, Phadke RV. Cerebral venous sinus
thrombosis in a tertiary care setting in India. QJM 2006;99:491–2.
Ehtisham A, Stern BJ. Cerebral venous thrombosis: a review.
Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging
of Cerebral Venous Thrombosis: current techniques, spectrum of
findings and diagnostic pitfalls. Radiographics 2006;26(Suppl
Dentali F, Gianni M, Crowther MA, Ageno W. Natural history of
cerebral vein thrombosis: a systematic review. Blood
Chowdhury RN, Rahman KM, Khan SU, Habib MDA, Miah T,
Ayaz KFM, et al. Cerebral venous sinus thrombosis: an update. J
Saadatnia M, Fatehi F, Basiri K, Mousavi SA, Mehr GK. Cerebral
venous sinus thrombosis risk factors. Int J Stroke 2009;4:111–23.
McBane RD 2nd, Tafur A, Wysokinski WE. Acquired and
congenital risk factors associated with cerebral venous sinus
thrombosis. Thromb Res 2010;126:81–7.
Bentley JN, Figueroa RE, Vender JR. From presentation to
follow-up: diagnosis and treatment of cerebral venous thrombosis.
Neurosurg Focus 2009;27:E4.
Pfefferkorn T, Crassard I, Linn J, Dichgans M, Boukobza M,
Bousser MG. Clinical features, course and outcome in deep
cerebral venous system thrombosis: an analysis of 32 cases. J
Cumurciuc R, Crassard I, Sarov M, Valade D, Bousser MG.
Headache as the only sign of cerebral venous thrombosis: a series
of 17 cases. J Neurol Neurosurg Psychiatry 2005:76;1084–7.
Wassay M, Kamal AK. Cerebral Venous Thrombosis: recent
advances and need for the Asian Registry. J Pak Med Assoc
Hameed B, Syed NA. Prognostic indicators in cerebral venous
sinus thrombosis. J Pak Med Assoc 2006;56:551–4.
J Ayub Med Coll Abbottabad 2012;24(1)
Smith R, Hourihan MD. Investigating suspected cerebral venous
thrombosis. BMJ 2007;334:794–5.
Rizzo L, Crasto SG, Rudà R, Gallo G, Tola E, Garabello D, et al.
Cerebral venous thrombosis: role of CT, MRI and MRA in the
emergency setting. Radiol Med 2010;115:313–25.
Boukobza M, Crassard I, Bousser MG, Chabriat H. MR imaging
features of isolated cortical vein thrombosis: diagnosis and followup. Am J Neuroradiol 2009;30:344–8.
Selim M, Caplan LR. Radiological diagnosis of cerebral venous
thrombosis. Front Neurol Neurosci 2008;23:96–111.
Challer B, Graf R. Cerebral Venous Infarction: The
pathophysiological concept; Cerebrovasc Dis 2004;18:179–88.
Siddiqui FM, Kamal AK. Complications associated with cerebral
venous thrombosis. J Pak Med Assoc 2006:56:547–50.
Usman U, Wassay M. Mechanism of neuronal injury in cerebral
venous thrombosis. J Pak Med Assoc 2006:56;509–12.
Santos GR, André R, Pereira SL, Parreira T, Machado E. Cerebral
venous thrombosis: retrospective analysis of 49 cases. Acta Med
Ferreira MM, Rios AC, Fragata I, Baptista JT, Manaças R, Reis J.
Cerebral venous thrombosis imagiologic features in a pregnant
woman. Acta Med Port 2011;24:193–8.
Linn J, Pfefferkorn T, Ivanicova K, Müller-Schunk S, Hartz S,
Wiesmann M, et al. Non-contrast CT in deep cerebral venous
thrombosis and sinus thrombosis: comparison of its diagnostic
value for both entities. Am J Neuroradiol 2009;30:728–35.
Liang L, Korogi Y, Sukahara T, Onomichi M, Shigematsu Y,
Yang D, et al. Evaluation of the intracranial dural sinuses with a
D contrast enhanced MP-RAGE sequence: Prospective
comparison with 2D-TOF MR venography and digital subtraction
angiography. Am J Neuroradiol 2001;22:481–92.
Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD,
Cucchiara B, Cushman M, et al. Diagnosis and management of
cerebral venous thrombosis: a statement for healthcare
professionals from the American Heart Association/American
Stroke Association. Stroke 2011;42:1158–92.
Stracke CP, Katoh M, Wiethoff AJ, Parsons EC, Spangenberg P,
Spüntrup E. Molecular MRI of cerebral venous sinus thrombosis
using a new fibrin-specific MR contrast agent. Stroke
Tsai FY, Wang AM, Matovich VB, Lavin M, Berberian B,
Simonson TM, et al. MR Staging of acute dural sinus thrombosis:
correlation with venous pressure measurements and implications
for treatment and prognosis. Am J Neuroradiol 1995:16;1021–9.
Anxionnat R, Blanchet B, Dormont D, Bracard S, Chiras J,
Maillard S, et al. Present status of computerized tomography
and angiography in the diagnosis of cerebral thrombophlebitis
cavernous sinus thrombosis excluded. J Neuroradiol
Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F,
ISCVT Investigators. Prognosis of Cerebral Vein and Dural Sinus
Thrombosis (ISCVT). Stroke 2004;35:664–70.