Brain lesions due to cerebral venous thrombosis do not correlate with sinus involvement

Abstract

Cerebral venous thrombosis may be well tolerated or lead to a brain lesion; availability of collateral venous pathways may explain the great variability of the lesions. This collateral circulation involves mainly medullary and cortical veins. These are difficult to assess neuroradiologically, particularly if thrombosed. Cerebral venous thrombosis is diagnosed usually based on thrombosis of dural sinuses and of the deep venous system. We tried to correlate the site and extent of dural sinus thrombosis with the location and the size of brain lesions in 26 consecutive patients with cerebral venous thrombosis, to investigate whether a simple causal relationship exists. No significant correlation between the extent and site of thrombosis in dural sinuses and the extent and location of brain lesions was found. In some cases a clear relationship between thrombosis of cortical and medullary veins and the lesions was evident. These data suggest that sinus thrombosis alone may be well tolerated in many cases, while involvement of cortical and medullary veins leads to a worse clinical situation.

Brain Lesions in Cerebral Venous Sinus Thrombosis

“…One smaller study attempted to correlate the site of the CVT to the distribution of parenchymal lesions in 26 patients, but no significant correlation between the extent and site of CSVT and the extent and location of brain lesions was found. 4 In our study, although the extent of CSVT correlated with the presence of parenchymal abnormalities, there were notable exceptions arguing that there were other factors contributing to the production of parenchymal lesions. Overestimation of the degree of thrombosis by MR venography in areas of very slow venous blood flow could explain some of the discrepancy.…”

Frequency and Topographic Distribution of Brain Lesions in Pediatric Cerebral Venous Thrombosis

“…It has been reported that there is no correlation between the location and the size of the brain lesions and the site and extent of the sinus thrombosis in adult patients, suggesting that adults might better tolerate CSVT. 6 However, the results of our study demonstrated good correlation between the site and extent of the sinus thrombosis and the location of the brain lesions in children except in 5 neonate patients. In these neonates, the site of the thrombosis was the transverse sinus, the sigmoid sinus, or the torcular, or all 3, whereas the site of the brain lesions also included the frontal or parietal lobes in addition to the territory of the transverse and sigmoid sinuses.…”

“…One potential supportive piece of evidence is that sinus thrombosis alone may be well tolerated in many cases, and the brain lesions resulting from cerebral venous thrombosis do not correlate with sinus involvement in adult patients. 6 If the venous collateral pathways are not readily open after sinus thrombosis, intravenous pressure may easily increase rapidly, which may cause injury to the blood-brain barrier very quickly. In addition, if the capillary reserve capacity does not function efficiently, a sufficient amount of cerebral blood volume may not be sustained, which may result in ischemic injury to the brain in the early stage of sinus thrombosis.…”

“…5 The lack of correlation between the extent and site of thrombosis in the dural sinuses and location of brain lesions has been suggested in adults. 6 In this study, our aims were to evaluate the frequency and topographic distribution of brain lesions associated with CSVT in children and to try and compare the topographic distribution of brain lesions with known normal venous drainage and anatomy.…”

Neonatal Cerebral Sinovenous Thrombosis From Symptom to Outcome

“…Kenet and colleagues suggest anticoagulation should be given on a patient-to-patient basis in children with newly identified SVT and high risk of recurrence. 32 In our study, choice for treatment highly depended on clinician preferences in the absence of guidelines. Severely affected neonates with deep or multisinus thrombosis, complicated by intracerebral hemorrhage, usually received none for fear of hemorrhagic complications (Figure 2).…”