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Background:Dural sinus thrombosis, along with the thrombosis of the deep or cortical cerebral venous system and the venous stroke resulting from it, is more common than once thought. Cerebral venous thrombosis (CVT) is a cause of stroke with diverse etiologies and varied clinical presentations. Its manifestations may simulate an acute arterial stroke or a mass lesion. The pathophysiology of CVT with associated venous strokes appears to differ from arterial strokes. Acute arterial strokes show cytotoxic edema, whereas venous strokes are thought to contain vasogenic and interstitial edoema due to venous congestion. MR imaging has been deemed to play a crucial role in diagnosing and evaluating this complex disease and, hence, has been progressively used to guide and direct its management.
Purpose:To study the various aspects of cerebral venous thrombosis in conventional and advanced MR imaging sequences
Methodology:This is a prospective observational study of 50 patients with cerebral venous thrombosis (CVT). Patients had undergone conventional MRI, diffusion-weighted imaging, and MR venogram. The diagnosis of CVT was confirmed with an MR venogram and other conventional MR sequences in 48 patients. MR contrast venography was done in 2 patients.
Result:In our study, headache was the most common symptom in 38/50 patients (76%), followed by a focal neurological deficit in 19/50 (38%), seizures, and vomiting in 13/50 patients (26% of each). In our study, the most common site of sinus thrombosis was found to be the superior sagittal sinus (70%), followed by the transverse and sigmoid sinuses (42% and 22%, respectively). The involvement of the deep venous sinus was only present in three (6%) patients. The sinus thrombus clot age was found to be in sync with clinical presentation and parenchymal imaging findings in 90% of cases, whereas in 10% of cases the sinus thrombus age was older than the parenchymal findings. Hemorrhagic infarct was identified in 40% of sinus thrombosis patients, intraparenchymal hematoma in 16% of patients, and non-hemorrhagic infarct in 38% of patients. In the acute phase, it was seen that in our study, most patients (7 patients) presented with a non-hemorrhagic infarct, whereas in the subacute phase, 18 cases were of hemorrhagic venous infarct. There was a significant correlation (with p-values less than 0.05) between the presence of hemorrhagic infarction in the subacute phase and intraparenchymal hematoma in the acute phase.
Conclusion:Evaluation of CVT is often a difficult task, but after the introduction of newer MR imaging techniques, it is possible to predict if brain lesions, detected clinically and using conventional MR imaging methods, may lead to full recovery, as expected in arterial infarcts and even a hematoma. Our research concludes that MRI is the best tool to evaluate CVT.
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