The Role of Magnetic Resonance Venography in Headache Due to Suspected Cerebral Venous Sinus Thrombosis in the Presence of Normal T1 and T2 Dural Sinus Signal
DOI:
https://doi.org/10.37762/jgmds.10-3.394Keywords:
Cerebral venous sinus thrombosis, Headache, MR VenographyAbstract
OBJECTIVES
Cerebral venous sinus thrombosis (CVST) is an important but uncommon aetiology of stroke. The presentation of CVST is extremely variable clinically, moreover its onset can be either acute or subacute, and less frequently, chronic. Headache is the most common symptom of CVST. The headache is typically diffuse and progressing in severity over days to weeks. MRI and MRV have very high sensitivity and specificity and have become the modality of choice to confirm the diagnosis of CVST. The aim of this study was to weigh the benefits of added MRV in patients with headache, after a negative MRI for CVST.
METHODOLOGY
The total number of patients included was 207, with chief complaints of headache and suspicion of CVST. The MRV sequence used was dynamic coronal by using the time-of-flight technique. The diagnosis of CVST was made by the loss of normal signal void both on T1WI and T2WI as well as on non-visualization on MRV.
RESULTS
Out of these 207 patients, CVST was present in 52 patients. Superior sagittal sinus was involved in 8 cases, right transverse sinus in 2 cases, left transverse sinus in 7 cases, left sigmoid sinus in 3 cases, and multiple sinuses in 32 cases. 34 cases out of 52 had infarction which was mostly haemorrhagic i.e. 27. A total of 97 cases (46%) had aplastic/hypoplastic transverse segments which were mostly the left one (87, 42%) and 10 cases (4.8 %) on the right side. In none of the patients, CVST was picked by MRV alone after a negative T1 and T2 MRI.
CONCLUSION
In patients presenting with headache and suspected CVST additional MRV is only required if the routine MR sequences are not able to pick up the thrombus and the suspicion of CVST is very high.
Downloads
Metrics
References
Dmytriw, Adam A., Jin Soo A. Song, Eugene Yu, and Colin S. Poon. "Cerebral venous thrombosis: state of the art diagnosis and management." Neuroradiology 60 (2018): 669-685 DOI: https://doi.org/10.1007/s00234-018-2032-2
Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVST). Stroke. 2004;35(3):664-70 DOI: https://doi.org/10.1161/01.STR.0000117571.76197.26
Saadatnia M, Fatehi F, Basiri K, Mousavi SA, Mehr GK. Cerebral venous sinus thrombosis risk factors. Int J Stroke. 2009; 4(2):111-23
Javed I, Sultan T, Rehman ZU, Yaseen MR. Clinical spectrum and outcome of cerebral venous sinus thrombosis in children. J Coll Physicians Surg Pak. 2018. 1;28(5):390-3 DOI: https://doi.org/10.29271/jcpsp.2018.05.390
Zafar ZA, Ali AZ. Pattern of magnetic resonance imaging and magnetic resonance venography changes in cerebral venous sinus thrombosis. J Ayub Med Coll Abbottabad. 2012. 1;24(1):63-7
Ferro JM, Canhão P. Cerebral venous sinus thrombosis: update on diagnosis and management. Curr Cardiol Rep. 2014; 16(9):523 DOI: https://doi.org/10.1007/s11886-014-0523-2
Cumurciuc R, Crassard I, Sarov M, Valade D, Bousser MG. Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases. J Neurol Neurosurg Psychiatry. 2005; 76(8):1084-7
Saposnik G, Barinagarrementeria F, Brown Jr RD, Bushnell CD, Cucchiara B, Cushman M, 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(4):1158-92 DOI: https://doi.org/10.1161/STR.0b013e31820a8364
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan; 38(1):1-211 DOI: https://doi.org/10.1177/0333102417738202
Rodallec MH, Krainik A, Feydy A, Hélias A, Colombani JM, Jullès MC, et al. Cerebral venous thrombosis and multidetector CT angiography: tips and tricks. Radiographics. 2006; 26(suppl_1):S5-18 DOI: https://doi.org/10.1148/rg.26si065505
Khan MW, Zeeshan HM, Iqbal S. Clinical Profile and Prognosis of Cerebral Venous Sinus Thrombosis. Cureus. 2020; 12(12) DOI: https://doi.org/10.7759/cureus.12221
Ozturk K, Soylu E, Parlak M. Dural venous sinus thrombosis: The combination of noncontrast CT, MRI and PC-MR venography to enhance accuracy. Neuroradiol J. 2018 ; 31(5):473-81 DOI: https://doi.org/10.1177/1971400918781969
Saadatnia M, Fatehi F, Basiri K, Mousavi SA, Mehr GK. Cerebral venous sinus thrombosis risk factors. Int J Stroke. 2009; 4:111–23 DOI: https://doi.org/10.1111/j.1747-4949.2009.00260.x
Sader N, de Lotbinière-Bassett M, Tso MK, Hamilton M. Management of venous sinus thrombosis. Neurosurg Clin N Am. 2018 1;29(4):585-94 DOI: https://doi.org/10.1016/j.nec.2018.06.011
Goyal G, Charan A, Singh R. Clinical presentation, neuroimaging findings, and predictors of brain parenchymal lesions in cerebral vein and dural sinus thrombosis: a retrospective study. Ann Indian Acad Neurol. 2018; 21(3):203-8 DOI: https://doi.org/10.4103/aian.AIAN_470_17
Damak M, Crassard I, Wolff V, Bousser MG. Isolated lateral sinus thrombosis: a series of 62 patients. Stroke. 2009; 40(2):476-81 DOI: https://doi.org/10.1161/STROKEAHA.107.509711
Goyal G, Singh R, Bansal N, Paliwal VK. Anatomical variations of cerebral MR venography: is gender matter?. Neurointervention. 2016 Sep;11(2):92 DOI: https://doi.org/10.5469/neuroint.2016.11.2.92
Cumurciuc R, Crassard I, Sarov M, Valade D, Bousser MG. Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases. Journal of neurology, neurosurgery and Psychiatry, Volume 76 issue 8, 2004 DOI: https://doi.org/10.1136/jnnp.2004.056275
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Fariha Afzal, Muhammad Imran Khan, Ujala Afridi, Alia Bangash
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
