Lateral sinus thrombosis may be difficult to differentiate angiographically from lateral sinus hypoplasia, which mainly affects its proximal transverse portion. Using magnetic resonance imaging, we evaluated six patients who demonstrated poor filling or lack of filling of one or both lateral sinuses at angiography. In each patient, magnetic resonance imaging unambiguously demonstrated either lateral sinus thrombosis or lateral sinus hypoplasia. The latter was characterized by a frank asymmetry in size (surface of section) of the transverse portion of the lateral sinuses on parasagittal images without any abnormal signal in the course of the sinus. Lateral sinus thrombosis was indicated by increased intraluminal signal on all planes and with all pulse sequences. By virtue of its freedom from bone-related artifact, its multiplanar imaging capability, and its sensitivity to both blood flow and thrombus formation, magnetic resonance imaging is an excellent tool for the evaluation of lateral sinus thrombosis or hypoplasia. (Stroke 1990;21:1350-1356) D ural sinus thrombosis is often difficult to diagnose because it presents with a wide spectrum of nonspecific clinical manifestations such as intracranial hypertension, focal signs, altered level of consciousness, and mental disturbances.12 One of the most frequent patterns, particularly when sinus thrombosis does not extend to the cerebral veins, is "benign intracranial hypertension," of which cerebral venous thrombosis is a wellestablished cause.Lateral sinus thrombosis is almost as common as superior sagittal sinus thrombosis, 1 but diagnosis of the former is more difficult. First, direct signs of lateral sinus thrombosis are difficult to assess on computed tomograms (CT scans).
"5 Second, it may be impossible at angiography to differentiate lateral sinus thrombosis from congenital hypoplasia, which mainly affects its proximal transverse portion. Recent reports 6 -13 have stressed the usefulness of magnetic resonance imaging (MRI) in the diagnosis of dural sinus thrombosis. We describe MRI findings in patients with lateral sinus hypoplasia or lateral sinus thrombosis that illustrate the value of MRI in differ- Received March 14, 1990; accepted May 15, 1990. entiating these two conditions, a distinction that can have major therapeutic implications.
Subjects and MethodsInclusion in this study was based solely on one criterion: the nonvisualization or poor visualization of one or both lateral sinuses at angiography. Each patient had selective opacification of both carotid arteries and a good-quality posterior fossa angiogram with opacification of the dominant vertebral artery or both vertebral arteries. In all patients MRI was performed on a Philips 0.5-T Gyroscan S15 (Eindhoven, The Netherlands) with a standard 30-cm head coil, using Tl-and T2-weighted spin-echo pulse sequences with a slice width of 8 mm and an interslice spacing of 0.8 mm. Parameters for Tl-weighted imaging included a repetition time (TR) of 450 msec and an echo time (TE) of 14 msec, whereas T2-weig...