Cerebral venous thrombosis as a diagnostic challenge: Clinical and radiological correlation based on the retrospective analysis of own cases

Zimny, Anna; Dziadkowiak, Edyta; Bladowska, Joanna; Chojdak-Łukasiewicz, Justyna; Loster-Niewińska, Aleksandra; Sąsiadek, Marek; Paradowski, Bogusław

doi:10.17219/acem/66778

Cited by 7 publications

(13 citation statements)

References 20 publications

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“…Accounting for 0.5% of all strokes; dural vein thrombosis is considered a rare etiological cause of stroke [ 4 ]. Rough estimates states that it can affect 3 to 4 individuals per million.…”

Section: Discussionmentioning

confidence: 99%

Venous and arterial cerebral thrombosis: a COVID-19 dual pathology and single possible etiology—a case report

Roushdy

Sharaf

2022

Egypt J Neurol Psychiatry Neurosurg

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Background Corona virus disease of the year 2019 (COVID-19) is still devastating the world for more than 19 months since its declaration as a pandemic by world health organization. Its manifestations does not stand at respiratory system but involves other body systems including central nervous system and its vasculature. In the following case report, cerebral venous and arterial thrombosis is detected in a case just in convalescence from COVID-19 with still detected positive IgM. Case presentation A 68-year-old female presenting with disturbed conscious level, bilateral convergent squint, single attack of generalized seizures, left sided dense weakness within a short time from catching COVID-19 and while still in quarantine hospital in recovery phase from infection. Magnetic resonance studies revealed bilateral cortical border zone infarcts as well as left lateral dural sinus and deep venous thrombosis. Conclusion Along the forth wave, COVID-19 is still hitting hardly the central nervous system vasculature.

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“…Accounting for 0.5% of all strokes; dural vein thrombosis is considered a rare etiological cause of stroke [ 4 ]. Rough estimates states that it can affect 3 to 4 individuals per million.…”

Section: Discussionmentioning

confidence: 99%

Venous and arterial cerebral thrombosis: a COVID-19 dual pathology and single possible etiology—a case report

Roushdy

Sharaf

2022

Egypt J Neurol Psychiatry Neurosurg

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“…Previously limited to case reports and small case series, CCVT diagnoses are mainly based on clinical symptoms and routine imaging features ( 3 ). Seizures are one of the most common symptoms of CCVT ( 1 , 4 – 6 ). Additionally, complications such as hemorrhagic infarctions ( 4 ), subarachnoid hemorrhages (SAH) ( 7 , 8 ), and arteriovenous fistulas (AVF) ( 9 – 11 ) may arise because of treatment delays.…”

Section: Introductionmentioning

confidence: 99%

“…Seizures are one of the most common symptoms of CCVT ( 1 , 4 – 6 ). Additionally, complications such as hemorrhagic infarctions ( 4 ), subarachnoid hemorrhages (SAH) ( 7 , 8 ), and arteriovenous fistulas (AVF) ( 9 – 11 ) may arise because of treatment delays.…”

Section: Introductionmentioning

confidence: 99%

High-Resolution Magnetic Resonance Black Blood Thrombus Imaging and Serum D-Dimer in the Confirmation of Acute Cortical Vein Thrombosis

et al. 2021

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Cerebral cortical vein thrombosis (CCVT) is often misdiagnosed because of its non-specific diagnostic symptoms. Here, we analyzed a cohort of patients with CCVT in hopes of improving understandings and treatments of the disease. A total of 23 patients with CCVT (confirmed with high-resolution imaging), who had been diagnosed between 2017 and 2019, were enrolled in this cohort study. Baseline demographics, clinical manifestations, laboratory data, radiological findings, treatment, and outcomes were collected and analyzed. Fourteen females and nine males were enrolled (mean age: 32.7 ± 11.9 years), presenting in the acute (within 7 days, n = 9), subacute (8–30 days, n = 7), and chronic (over 1 month, n = 7) stages. Headaches (65.2%) and seizures (39.1%) were the most common symptoms. Abnormally elevated plasma D-dimers were observed in the majority of acute stage patients (87.5%). The diagnostic accuracy of contrast-enhanced magnetic resonance venography (CE-MRV) and high-resolution magnetic resonance black-blood thrombus imaging (HR-MRBTI) in detecting CCVT were 57.1 and 100.0%, respectively. All patients had good functional outcomes after 6-month of standard anticoagulation (mRS 0–1) treatment. However, four CCVT patients that had cases involving multiple veins showed symptom relief after batroxobin therapy (p = 0.030). HR-MRBTI may be a fast and accurate tool for non-invasive CCVT diagnosis. HR-MRBTI combined with D-dimer can also precisely identify the pathological stage of CCVT. Batroxobin may safely accelerate cortical venous recanalization in combination with anticoagulation. Follow-up studies with larger sample sizes are suggested to evaluate the safety and efficacy of batroxobin for treating CCVT.

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“…It must be stressed that due to non-specific clinical symptoms, neuroimaging plays a crucial role in the initial prompt diagnosis. Emergency CT is usually performed without contrast administration [ 5 , 6 ] and may show hyperdense thrombi within cerebral veins or dural sinuses as well as findings secondary to venous congestion such as generalized brain swelling, areas of hypodense local oedema, or venous haemorrhagic infarctions [ 5 ]. Computed tomography with iodine contrast injection is sometimes used in emergency settings and may show filling defects within thrombosed veins or dural sinuses, gyral enhancement, or prominent intramedullary veins [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Emergency CT is usually performed without contrast administration [ 5 , 6 ] and may show hyperdense thrombi within cerebral veins or dural sinuses as well as findings secondary to venous congestion such as generalized brain swelling, areas of hypodense local oedema, or venous haemorrhagic infarctions [ 5 ]. Computed tomography with iodine contrast injection is sometimes used in emergency settings and may show filling defects within thrombosed veins or dural sinuses, gyral enhancement, or prominent intramedullary veins [ 5 ]. The gold standard in the diagnosis of CVT is the use of venographies with contrast injection, such as CT venography, magnetic resonance (MR) venography, or conventional digital subtracted angiography (DSA), which are the best examinations for the assessment of morphology and patency of dural sinuses and veins.…”

Section: Introductionmentioning

confidence: 99%

Acute cerebral venous thrombosis – still underdiagnosed pathology in the emergency computed tomography of the brain

Jacków-Nowicka¹,

Jagiello²,

Dziadkowiak³

et al. 2021

Pol J Radiol

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IntroductionAcute cerebral venous thrombosis (CVT) is a rare condition that can lead to a serious clinical state; thus, prompt diagnosis and treatment are mandatory. Head computed tomography (CT) plays a crucial role in the initial prompt diagnosis in the emergency setting. The aim of the study was to retrospectively analyse emergency head CT studies and the rate of incorrect diagnoses and main sources of pitfalls.Material and methodsRetrospective analysis of 31 emergency CT studies (22 without contrast, 19F/12M, age range: 4-94 years) of patients with confirmed acute CVT.ResultsThrombosed dural sinuses were found in 24/31 (77.4%) cases, thrombosed veins in 7/31 (22.6%) cases, no lesions within vessels in 2/31 (6.5%) cases. Haemorrhagic brain lesions were found in 9/31 (29%) cases, hypodense oedema in 6/31 (19.6%) cases, brain swelling in 1/31 (3.2%) cases, and no parenchymal lesions were revealed in 15/31 (48.4%) cases. Correct diagnosis of CVT was established in 15 cases (48.4%); however, it was incorrect in 16 cases (51.6%). Incorrect cases consist of 4 groups: 1 – with both vascular and parenchymal lesions that were overlooked (50%), 2 – with vascular lesions only, which were either overlooked, misinterpreted, or covered by artefacts (31.3%,), 3 – with parenchymal lesions only, which were misinterpreted (12.5%), and 4 – with no lesions present in the emergency head CT (6.2%).ConclusionsThe high rate of incorrect diagnoses of acute CVT based on emergency head CT requires constant training of radiologists and their close cooperation with clinicians because a delayed diagnosis may be lethal to the patient.

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Cerebral venous thrombosis as a diagnostic challenge: Clinical and radiological correlation based on the retrospective analysis of own cases

Abstract: Background. Cerebral venous thrombosis (CVT) is a rare condition which constitutes 0.5-1% of all strokes. The clinical and radiological picture of CVT is non-specific and can mimic other disorders.

Cited by 7 publications

References 20 publications

Venous and arterial cerebral thrombosis: a COVID-19 dual pathology and single possible etiology—a case report

Venous and arterial cerebral thrombosis: a COVID-19 dual pathology and single possible etiology—a case report

High-Resolution Magnetic Resonance Black Blood Thrombus Imaging and Serum D-Dimer in the Confirmation of Acute Cortical Vein Thrombosis

Acute cerebral venous thrombosis – still underdiagnosed pathology in the emergency computed tomography of the brain

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