Abstract
Cerebral venous thrombosis (CVT) and cerebral venous infarcts (CVI) are diagnostic dilemmas secondary to their rarity, non-specific symptomatology at presentation, and variable imaging features. Despite its relatively infrequence, CVT is particularly prevalent in the younger adult population and is a potentially life-threatening disease with devastating neurological complications if not addressed in a timely manner. However, when treated promptly, CVT has the potential for a more reversible course and favorable prognosis than arterial ischemic strokes (AIS). The pathophysiology of CVI is distinct from that of AIS and is closely related to its potentially reversible nature. Familiarity with the conventional and variant venous anatomy, as well as the temporal evolution of imaging findings, is crucial in establishing diagnostic confidence. The use of MR perfusion imaging (MRP) and arterial spin-labeling (ASL) can potentially aid in the diagnosis of CVT/CVI via characterization of cerebral blood flow. The presence and extent of a cerebral perfusion deficit on either CT or MRI may play a role in clinical outcomes for patients with CVT, although future larger studies must be performed. This review presents a case-based overview focusing on the classic imaging characteristics of CVT and CVI in conjunction with bolus MRP and ASL findings in the adult population.
Highlights
Cerebral venous infarct (CVI) is an uncommon cause of all strokes (0.5–2%) that disproportionately affects young adults (1, 2)
cerebral venous thrombosis (CVT) and CVI have an estimated mortality of 5–30%, expeditious diagnosis and treatment generally leads to a favorable prognosis with up to 80% of patients recovering without functional disability (3, 4)
50% of cerebral venous occlusions progress to CVI, which constitute rare, Comprehensive Review of Cerebral Venous Infarcts non-arterial distribution infarcts secondary to increases in venous pressure resulting in ischemia (6–8)
Summary
Cerebral venous infarct (CVI) is an uncommon cause of all strokes (0.5–2%) that disproportionately affects young adults (1, 2). CVI is most commonly caused by cerebral venous thrombosis (CVT). CVT refers to the complete or partial occlusion of the dural venous sinuses and/or cerebral veins with potentially devastating clinical consequences if untreated. 50% of cerebral venous occlusions progress to CVI, which constitute rare, Comprehensive Review of Cerebral Venous Infarcts non-arterial distribution infarcts secondary to increases in venous pressure resulting in ischemia (6–8). For this reason, a recent study has defined CVI as venous parenchymal lesions with three subtypes, namely, hemorrhagic ischemia (HI), intracerebral hematoma (ICH), and non-hemorrhagic ischemia (NHI) (9).
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