Cerebral vein thrombosis: clinical manifestation and diagnosis

Abstract

BackgroundCerebral venous thrombosis (CVT) is a disease with a wide spectrum of symptoms and severity. In this study we analysed the predictive value of clinical signs and symptoms and the contribution of D-dimer measurements for diagnosis.MethodsWe evaluated consecutive patients admitted with suspected CVT receiving non-invasive imaging. Symptoms and symptom combination as well as D-dimer levels were evaluated regarding their diagnostic value.Results239 patients were included in this study, 170 (71%) were females. In 39 patients (16%) a CVT was found. For identifying a CVT patients underwent either a venous CT-angiography or MR-angiography or both. No combination of symptoms either alone or together with the D-dimer measurements had a sensitivity and positive predictive value as well as negative predictive value and specificity high enough to serve as red flag. D-dimer testing produced rates of 9% false positive and of 24% false negative results. For D-dimer values a Receiver Operating Characteristic curve (ROC) and the area under the curve (AUC = 0.921; CI: 0.864 - 0.977) were calculated. An increase of sensitivity above 0.9 results in a relevant decrease in specificity; a sensitivity of 0.9 matches a specificity value of 0.9. This corresponds to a D-dimer cut-off level of 0.16 μg/ml.ConclusionImaging as performed by venous CT-angiography or MR-angiography has a 1 to 2 in 10 chance to detect CVT when typical symptoms are present. D-dimer measurements are of limited clinical value because of false positive and negative results.

Cerebral venous thrombosis presenting with headache only and misdiagnosed as subarachnoid hemorrhage

“…Additionally, headache may be the only symptom of CVT, and other symptoms and signs of intracranial hypertension, subarachnoid hemorrhage, meningitis, or an intracranial mass may be absent. [5,6] In our patient, no predisposing factor was identified and the neurological examination was completely normal.…”

Espectros Clínicos da Trombose Venosa Cerebral

“…Sinais de TVC na tomografia incluem hiperdensidade em seios ou veias corticais (sinal da corda) e defeitos de enchimento especialmente no seio sagital superior, com o sinal do delta vazio quando usado contraste endovenoso. A venografia por TC é uma forma rápida e segura de realizar o diagnóstico de TVC, especialmente em pacientes que tem contraindicações à realização de RM de crânio 1,2 . A RM de encéfalo com angio-RM com fase venosa é o exame de escolha para o diagnóstico de TVC nas fases aguda, subaguda e crônica.…”

“…As lesões com infartos ou hemorragias são bem vistas na RM de encéfalo. A angiografia cerebral digital deve ser realizada em casos de dúvida diagnóstica ou quando se considera a realização de procedimento endovascular 1,2 Neste estudo, a primeira causa de morte na fase aguda foi herniação cerebral, geralmente consequência de grandes infartos hemorrágicos 11 . Embora uma grande parte dos pacientes melhore total ou parcialmente, 10% apresentam déficits permanentes nos primeiros 12 meses.…”

“…Quatro síndromes maiores foram descritas em pacientes com TVC: hipertensão intracraniana isolada, déficits neurológicos focais, crises epilépticas e rebaixamento do nível de consciência 2,3 .…”

A case of surgically treated hemorrhagic herpes encephalitis complicated by a sigmoid sinus vein thrombosis

“…CVT is a serious and potentially fatal type of stroke. Overall, CVT is uncommon, with an annual incidence of 3.4/100,000 per year in our population (Bousser et al, 1985;Breteau et al, 2003;Chan et al, 2005;Mak et al, 2001;Tanislav et al, 2011). Thrombosis may produce venous congestion with a resultant rise in intracranial pressure (ICP), cerebral ischemia and venous infarction.…”