This article reviews the radiologic findings and diagnostic pitfalls of cerebral venous thrombosis. After completing this article, the readers should have an improved ability to diagnose cerebral venous thrombosis accurately, using the optimal imaging tools to achieve this goal.

Gossypol, a polyphenolic compound which depletes cellular energy by inhibition of several intracellular dehydrogenases, has been shown to have antiproliferative activity against human glial tumor cell lines in vitro and in nude mouse xenografts. Human trials of gossypol as a male contraceptive have demonstrated safety of long-term administration. We studied the activity of Gossypol 10 mg PO bid in 27 patients with pathologically confirmed glial tumors which had recurred after radiation therapy. Fifteen patients had glioblastoma, 11 patients anaplastic astrocytoma, 1 patient relapsed low grade glioma. Response was assessed every 8 weeks using CT/MRI scan and clinical criteria including decadron requirement. Treatment was continued until disease progression. Two patients had partial response (PR); 4 had stable disease for 8 weeks or more. One patient maintained a PR with improved KPS for 78 weeks. The other had a PR lasting 8 weeks. Toxicity was mild: 2 heavily pretreated patients had mild thrombocytopenia, 5 patients developed hypokalemia, 3 patients developed grade 2 hepatic toxicity and peripheral edema. Gossypol levels measured by HPLC did not correlate with response or toxicity in this study. We conclude that gossypol is well tolerated and has a low, but measurable, response rate in a heavily pretreated, poor-prognosis group of patients with recurrent glioma. The presumed novel mechanism of action, lack of significant myelosuppression, and activity in patients with advance glioma support further study of gossypol as an antineoplastic agent.

This prospective study examined the efficacy of magnetic resonance imaging (MRI) in visualizing cerebrospinal fluid (CSF) leak in patients with postdural puncture headache (PDPH) and determining the spread of the blood patch in the epidural space and the extent of tamponade on the thecal sac. After obtaining institutional review board approval, five patients with symptomatic PDPH after 3 days of failed conservative treatment were included in this study. MRI using proton density (PD) and T2-weighted imaging was performed on all patients and CSF flow studies were done on one patient. All patients received 20 mL of blood in the epidural space. They remained supine for 45 min, and repeat MRI studies were performed. Extent of the spread of blood in the epidural space was measured. A visual analog scale of 0-10 was used to evaluate the headache. All patients had severe postural headache with nausea/vomiting. Preblood patch MRI showed extrathecal CSF and hemosiderosis indicating the site of dural puncture in four patients. The postprocedure MRI demonstrated the blood patch as a large extradural collection with anterior displacement of the thecal sac, the mean spread being 4.6 intervertebral spaces. The tamponade effect of the blood patch was observed on PD, T2-weighted, and CSF flow images. All patients experienced immediate resolution of their symptoms. This study suggests that using MRI, the site of the CSF leak, the tamponade effect of the blood patch, and its spread in the epidural space can be documented.

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