Cerebral venous sinus thrombosis on MRI: A case series analysis

Abstract

Background: Cerebral venous sinus thrombosis (CVST) is a rare form of stroke seen in young and middle aged group, especially in women due to thrombus of dural venous sinuses and can cause acute neurological deterioration with increased morbidity and mortality if not diagnosed in early stage. Neurological deficit occurs due to focal or diffuse cerebral edema and venous non-hemorrhagic or hemorrhagic infarct. Aim and Objectives: To assess/evaluate the role of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Venography (MRV) as an imaging modality for early diagnosis of CVST and to study patterns of venous thrombosis, in detecting changes in brain parenchyma and residual effects of CVST using MRI. Materials and Methods: Retrospective descriptive analysis of 40 patients of CVST diagnosed on MRI brain and MRV was done. Results: 29/40 (72.5%) were males and 11/40 (27.5%) were females. Most of the patients were in the age group of 21-40 years (23/40-57.5%). Most of the patients 16/40 (40%) presented within 7 days. No definite cause of CVST was found in 24 (60%) patients in spite of detailed history. In 36/40 (90%) of cases major sinuses were involved, deep venous system were involved in 7/40 (17.5%) cases, superficial cortical vein was involved in 1/40 (2.5%) cases. Analysis of stage of thrombus (acute, subacute, chronic) was done based on its appearance on T1 and T2WI. 31/40 (77.5%) patients showed complete absence of flow on MRV, while 9/40 (22.5%) cases showed partial flow on MR venogram. Brain parenchyma was normal in 20/40 (50%) patients while 6/40 (15%) cases had non-hemorrhagic infarct and 14/40 (35%) patients presented with hemorrhagic infarct. Conclusion: Our study concluded that MRI brain with MRV is sensitive in diagnosing both direct signs (evidence of thrombus inside the affected veins) and indirect signs (parenchymal changes) of CVST and their follow up.