Cerebral cortical and deep venous thrombosis without sinus thrombosis: clinical MRI correlates

Abstract

Computerized tomography, conventional MRI and diffusion-weighted imaging showing ischemic and/or hemorrhagic lesion that does not follow the boundary of classical arterial boundaries without signs of sinus thrombosis, and partial or generalized seizures followed by focal neurologic signs may predict CDVT. The outcome of patients with cortical venous stroke was good, but not in those with cortical plus deep venous infarction.

Diagnosis and Management of Cerebral Venous Thrombosis

“…© 2011 American Heart Association, Inc. [2,10,42,70,71,73,74,91,[98][99][100]105,106,108,[113][114][115][116][117][118][119][120][121][122][123][124][125][126][127][128] 。随着血栓的演变， 静脉窦内出现脱氧血红蛋白和氧化血红蛋白的顺磁 性代谢产物。此时硬膜窦或静脉内血栓在梯度回波 和磁敏感加权磁共振成像上呈低信号 [70,119,129] [196,197,209] 。 几项研究报告了 CVT 病人抽搐发作的发生率和 特征。一项研究报道 [218] ，在 91 例病人中，32% 以 抽搐发作就诊， 2% 在住院期间出现抽搐发作， 仅 9.5% 出现晚期抽搐发作，此外，抽搐发作并不是 1 年预 后的预测指标。早期抽搐发作在有 CT/MRI 上脑实 质病变的病人中发生的可能性高达 3.7 倍 (95% CI 1.4-9.4) 而在有感觉缺失的病人中的可能性增加 7.8 倍 (95% CI 0.8-74.8)。来自 ISCVT 的一项更近的报 告 [197] 显示，624 例病人中的 245 例 (39%) 以抽搐发 作就诊，而 43 例 (6.9%) 在诊断后 2 周内出现早期 抽搐发作。除了就诊时抽搐发作，仅诊断时 CT/MRI 上有幕上脑实质病变 ( 见于 58%) 与早期抽搐发作的 发生有关 (OR 3.1, 95% CI 1.6-9.6)。此外，在有幕上 病变而起病时没有抽搐发作的病人中，应用抗癫痫 药物可使 2 周内抽搐发作的风险降低 70%，尽管这 并没有统计学上的显著性 (OR 0.3, 95% CI 0.04-2.6)。 在这些结果的基础上，作者建议对表现为抽搐发作 的有幕上病变的急性 CVT 病人使用抗癫痫药物 [197] 。 脑积水 上矢状窦和横窦是通过横跨静脉窦壁突入到 蛛网膜下腔并引流到静脉系统的高度血管化结构的 蛛网膜颗粒进行脑脊液 (CSF) 吸收的主要部位。在 CVT，蛛网膜颗粒的功能可能受到障碍，潜在地导 致 CSF 吸收的衰竭和交通性脑积水 (6.6%) [14,198] 。 梗阻性脑积水是 CVT 的一个少见的并发症，可 由出血破入脑室系统所致。通常与累及大脑内静脉的 血栓有关，还可以与丘脑出血有关。此综合征在新生 儿已有很好的描述但可以发生在所有年龄组 …”

“…Anatomic variants of normal venous anatomy may mimic sinus thrombosis, including sinus atresia/hypoplasia, asymmetrical sinus drainage, and normal sinus filling defects related to prominent arachnoid granulations or intrasinus septa. 2,71,72,95,97,106,108,109,125,[142][143][144][145][146][147][148][149][150]158 Angiographic examination of 100 patients with no venous pathology 159 showed a high prevalence of asymmetrical lateral (transverse) sinuses (49%) and partial or complete absence of 1 lateral sinus (20%).…”

“…MRI signal can also predict radiographic outcome to some extent, because DWI abnormality within veins or sinus predicts poor recanalization. 71,105,110,[117][118][119][131][132][133]135,140,141 CT Venography CTV can provide a rapid and reliable modality for detecting CVT ( Figure 9). CTV is much more useful in subacute or chronic situations because of the varied density in thrombosed sinus ( Figure 10).…”

“…It does have several potential pitfalls in imaging interpretation (see "Potential Pitfalls in the Radiological Diagnosis of CVT: Anatomic Variants, Thrombus Signal Variability, and Imaging Artifacts" below). 2,71,72,95,97,106,108,109,125,[142][143][144][145][146][147][148][149][150] Despite the challenges, other sequences such as gradient echo, susceptibilityweighted imaging, and contrast MRI/MRV may assist in these situations. 129,151 Nonthrombosed hypoplastic sinus will not have abnormal low signal in the sinus on gradient echo or susceptibility-weighted images.…”

The Diagnosis and Treatment of Cerebral Venous Thrombosis

“…Homonymous hemianopsia, contralateral weakness, epileptic seizures, and aphasia due to involvement of cortical veins may be observed. Thalamic and basal ganglia infarct due to involvement of the internal cerebral vein, vein of Galen, and straight sinus, and related symptoms may occur in approximately 16% of cases (13,14).…”