Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2017, vol. 26, nr 7, October, p. 1113–1122

doi: 10.17219/acem/66778

Publication type: original article

Language: English

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

Anna Zimny1,A,B,C,D,F, Edyta Dziadkowiak2,B,C,D,F, Joanna Bladowska1,C,D,E,F, Justyna Chojdak-Łukasiewicz2,B,C,D,F, Aleksandra Loster-Niewińska2,B,C,D,F, Marek Sąsiadek1,A,E,F, Bogusław Paradowski3,A,E,F

1 Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland

2 Department of Neurology, Medical University Hospital, Wrocław, Poland

3 Department of Neurology, Wroclaw Medical University, Poland

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.
Objectives. The aim of the study was to retrospectively evaluate and correlate clinical and radiological symptoms presented by patients with CVT, both in the initial and follow-up neurological and neuroimaging examinations, with a special emphasis on diagnostic difficulties.
Material and Methods. Material consisted of 11 patients with CVT (7 women, 4 men). The average age was 43.5, ranging from 23 to 69 years. Clinical symptoms, laboratory findings, risk factors and the results of neuroimaging examinations including CT, MRI and DSA were retrospectively analyzed and correlated.
Results. All subjects developed superficial CVT and 1 also deep CVT, with no parenchymal lesions in 2 cases, non-hemorrhagic infarctions in 3 and hemorrhagic lesions in 6 subjects. The most frequent symptoms were headache, seizures and hemiparesis. The major risk factors were hormonal therapies in women and congenital thrombophilia. Factors influencing the clinical course and outcome the most were location and type of brain lesions, with hemorrhagic cortical infarctions bringing the worst prognosis and being associated with the highest rate of persistent neurological deficits, despite the rate of vessel recanalization.
Conclusion. In our opinion, quick diagnosis before parenchymal hemorrhagic lesions are visible on CT is of crucial importance and requires a constant alertness and good cooperation of neurologists and radiologists, especially in emergency settings.

Key words

cerebral venous thrombosis, headache, diagnostic imaging

References (21)

  1. Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol. 2007;6:162–170.
  2. Saposnik G, Barinagarrementeria F, Brown RD, et al. Diagnosis and Management of Cerebral Venous Thrombosis. A Statement for Healthcare Professionals From the American Heart Association /American Stroke Association. Stroke. 2011;42:1158–1192.
  3. Masuhr F, Mehraein S, Einhaupl K. Cerebral venous and sinus thrombosis. J Neurol. 2004;251:11–23.
  4. Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005;352:1791–1798.
  5. Appenzeller S, Zeller CB, Annichino-Bizzachi JM, et al. Cerebral venous thrombosis: Influence of risk factors and imaging findings on prognosis. Clin Neurol Neurosurg. 2005;107:371–378.
  6. Bousser MG, Crassard I. Cerebral venous thrombosis, pregnancy and oral contraceptives. Thromb Res. 2012;130(suppl 1):19–22.
  7. Ferro JM, Canhao P, Stam J, Bousser MG, Barinagarrementeria F, ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004;35:664–670.
  8. Leach J, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: Current techniques, spectrum of findings, and diagnostic pitfalls. RadioGraphics. 2006;26:19–43.
  9. Qu H, Yang M. Early imaging characteristics of 62 cases of cerebral venous sinus thrombosis. Exper and Therap Med. 2013;5:233–236.
  10. Yii IY, Mitchell PJ, Dowling RJ, Yan B. Imaging predictors of clinical deterioration in cerebral venous thrombosis. J Clin Neurosci. 2012;19:1525–1529.
  11. Einhaupl K, Bousser MG, de Bruijn SF, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis. Eur J Neurol. 2006;13:553–559.
  12. Cumurciuc R, Crassard I, Sarov M, Valade B, Bousser MG. Headache as the only neurological sign of cerebral venous thrombosis: A series of 17 cases. J Neurol Neurosurg Psychiatry. 2005;76:1084–1087.
  13. Talbot K, Wright M, Keeling D. Normal D-dimer levels do not exclude the diagnosis of cerebral venous thrombosis. J Neurol. 2002;249:1603–1604.
  14. Crassard I, Soria C, Tzurio Ch, et al. A negative D-dimer assay does not rule out cerebral venous thrombosis: A series of 73 patients. Stroke. 2005;36:1716–1719.
  15. Viraponge C, Cazenave C, Quisling R, Sarwar M, Hunter S. The empty delta sign: Frequency and significance in 76 cases of dural sinus thrombosis. Radiology. 1987;162:779–785.
  16. Ducreux D, Oppenheim C, Vandamme X, et al. Diffusion-weighted imaging pattern of brain damage associated with cerebral venous thrombosis. AJNR. 2001;22:261–268.
  17. Selim M, Fink J, Llinfante I, Kumar S, Schlaug G, Caplan LR. Diagnosis of cerebral venous thrombosis with echo-planar T2*-weighted magnetic resonance imaging. Arch Neurol. 2002;59:1021–1026.
  18. Farb RI, Scott JN, Willinsky RA, Montanera WJ, Wright GA, terBrugge KG. Intracranial venous system: Gadolinium-enhanced three-dimentional MR venography with auto-triggered elliptic centric-ordered sequence – initial experience. Radiology. 2003;226:203–209.
  19. Vogl TJ, Bergman C, Villringer A, Einhaupl K, Lissner J, Felix R. Dural sinus thrombosis: Value of venous MR angiography for diagnosis and follow-up. AJR. 1994;162:1191–1198.
  20. van der Bergh WM, van der Schaaf I, van Gijn J. The spectrum of presentation of venous infarction caused by deep cerebral vein thrombosis. Neurology. 2005;65:192–196.
  21. Stolz E, Trittmacher S, Rahimi A, et al. Influence of recanalization on outcome in dural sinus thrombosis: A prospective study. Stroke. 2004;35:544–547.
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