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NEUROIMAGE
Year : 2020  |  Volume : 68  |  Issue : 1  |  Page : 234-235

Early Detection of Deep Cerebral Venous Sinus Thrombosis


1 Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
2 Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea

Date of Web Publication28-Feb-2020

Correspondence Address:
Dr. Yerim Kim
Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150 Seongan-ro, Gangdong-gu, Seoul - 05355
Republic of Korea
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.279655

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How to cite this article:
Lee J, Kim Y. Early Detection of Deep Cerebral Venous Sinus Thrombosis. Neurol India 2020;68:234-5

How to cite this URL:
Lee J, Kim Y. Early Detection of Deep Cerebral Venous Sinus Thrombosis. Neurol India [serial online] 2020 [cited 2020 Apr 7];68:234-5. Available from: http://www.neurologyindia.com/text.asp?2020/68/1/234/279655




Cerebral venous sinus thrombosis (CVST) is a rare phenomenon associated with occlusion of venous sinuses of the brain. Clinically, it presents wide variability including, headache, confusion, and stroke-like symptoms.[1] Imaging varies from subtle findings to complex infarctions, vasogenic edema, and hemorrhages.[2]

Herein, we report an uncommon case of CVST with visualization of the internal cerebral vein in multiphasic computed tomography angiography (MCTA).

A 76-year-old man was presented to the emergency department with a confused mentality and left side weakness. His MCTA showed no large arterial occlusion, but branches of internal cerebral veins were observed on the venous phase [Figure 1]a. On magnetic resonance imaging (MRI), diffuse hyperintensity was seen on bilateral thalamus in T2-weighted image and fluid-attenuated inversion recovery (FLAIR) [Figure 1]b. Venogram showed occlusion of the vein of Galen and straight sinus [Figure 1]c. Low-molecular-weight heparin (LMWH) was started with a dose of 1 mg/kg twice a day.
Figure 1: (a) Branches of internal cerebral veins could be seen on the venous phase of multiphasic CT angiography (MCTA). (b) Diffuse hyperintensity of bilateral thalamus in fluid-attenuated inversion recovery (FLAIR). (c) Occlusion of the vein of Galen and straight sinus

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CVST is a relatively uncommon condition, representing approximately 0.5–1% of all strokes. Among them, deep CVST is even less in number.[1] Since bilateral thalamic lesions based on MRI include a wide variety of differential diagnosis involving metabolic, infectious, and vascular disorders, early detection of CVST is difficult.[3],[4] However, considering the poor prognosis of deep CVST, finding an imaging marker to predict the disease holds a great clinical significance. Although genetic factors are known to be related to CVST, genetic testing is not available in all patients. Therefore, the visualization of internal cerebral veins in MCTA may play a predicting role in early diagnosis. When the deep venous occlusion occurs in deep CVST, the congestion of internal cerebral veins could be seen in MCTA. With this early predictive imaging marker, faster initiation of treatment may be expected, thus improving prognosis in deep CVST.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This research was supported by the Basic Science Research Program through the National Research. Foundation of Korea (NRF) funded by the Ministry of Science and ICT (NRF-2018R1C1B5086320) and was supported by a grant no 2019-08 from the Kangdong Sacred Heart Hospital Fund.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alvis-Miranda HR, Catellar-Leones SM, Alcala-Cerra G, Moscote-Salazar LR. Cerebral Sinus Venous Thrombosis. J Neurosci Rural Pract 2013;4:427-38.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Lu A, Shen PY, Dalhin BC, Nidecker AE, Nundkumar A, Lee PS. Cerebral venous thrombosis and infarct: Review of imaging manifestations. Appl Radiol 2016;45:9-17.  Back to cited text no. 2
    
3.
Smith AB, Smirniotopoulos JG, Rushing EJ, Goldstein SJ. Bilateral thalamic lesions. Am J Roentgenol 2009;192:53-62.  Back to cited text no. 3
    
4.
Menon G, Nair S, Sudhir J, Rao BR, Krishnakumar K. Bilateral thalmic lesions. Br J Neurosurg 2010;24:566-571.  Back to cited text no. 4
    


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