Dural sinus thrombosis identified by point-of-care ultrasound

Abstract

Dural sinus thrombosis (DST), or cerebral venous thrombosis, is an uncommon cause of stroke. It has a variable presentation, and the symptoms and signs can be non-specific. The diagnosis of DST can be difficult to make and is often delayed or missed. Computed tomography venography or magnetic resonance venography are the typical imaging modalities used to diagnose DST. However, computed tomography venography and magnetic resonance venography both have limitation for emergency department patients. In this article, we report the use of point-of-care ultrasound to facilitate the diagnosis of DST.

Brachiocephalic Vessels Ultrasound Index of Arteriovenous Ratio (IAVR) and Headache as a Diagnostic Tool for Intracranial Venous Stasis in Arterial/Venous Ischemic Stroke’s Differentiation

“…It is noteworthy that the use of non-invasive (including ultrasound) techniques in the AHA/ASA 2018 recommendations is considered preferable in cases where the subsequent implementation of mechanical thromboextraction is not implied, while the use of multimodal (using MSCT and MRI) approach to the diagnosis of stroke is not recommended due to a possible delay in the decision to perform thrombolytic therapy (Class III, level of evidence B, randomized trials is no exist) [30]. Assessment of velocity parameters in the Galen vein and Rosenthal veins during transcranial scanning is an additional indirect sign of intracranial venous stasis, but the use of the method is limited by the absence of an acoustic window according to various data in 10-20% of cases [31][32][33]. The use of ultrasonic IAVR (within the protocol of color duplex scanning of brachiocephalic vessels), as well as the assessment of headache intensity according to the visual analogue scale in the developed model, improve the quality of early diagnosis of acute ischemic stroke and get the predicted likelihood of a patient having a venous stroke without the need for the cumbersome formula presented above.…”

Clinical and instrumental indicators of intracranial venous stasis and secondary ischemia in cerebral sinus thrombosis. A review

“…Transcranial duplex scanning is usually performed upon admission to the hospital. Assessment of velocity parameters in the Galen vein and Rosenthal veins during transcranial scanning is an additional indirect sign of intracranial venous stasis, but the use of the method is limited by the absence of an acoustic window [94] according to various data in 10-20% of cases [95][96][97]. The following indirect signs of intracranial venous stasis are obtained with transcranial Doppler: an increase in the maximum blood flow velocity in one or both Rosenthal veins over 25 cm/s, Galen's vein and straight dural sinus > 30 cm/s, the appearance of a pseudopulsation effect, a decrease in the cerebrovascular reactivity index <40%, resistance index increase > 20%.…”