Presence Of Cerebral Venous Sinus Thrombosis Research Articles

Dural arteriovenous fistula in the setting of cerebral venous sinus thrombosis and COVID-19 infection.

The aim of this study was to examine the presence of concurrent venous thrombosis and COVID-19 infections in patients with dural arteriovenous fistulas (dAVFs). An analysis of all patients diagnosed with dAVF via cerebral angiography by the senior author was conducted, with special attention given to the presence of cerebral venous sinus thrombosis (CVST) and COVID-19 infection. General demographics, clinical presentation, presence of CVST, and COVID-19 infection status were reported. A total of 30 patients with dAVFs were included in this study. Three patients were diagnosed with COVID-19 (10%), with one of these patients developing CVST (33%) at 6 months postinfection. Of the 27 patients not infected with COVID-19, one was diagnosed with a likely chronic CVST at the time of presentation of dAVF (4%). A total of 11 case reports and 3 retrospective studies describing patients diagnosed with CVST at or after diagnosis of dAVFs have been reported in the literature. The incidence of dAVFs in patients with CVST has been reported as 2.4%, and the incidence of dAVF has reportedly increased five- to tenfold since the COVID-19 pandemic. COVID-19 infections may pose as an emerging risk factor for the development of CVST and subsequent dAVF development. To the authors' knowledge, this study presents the first cases in the literature describing a temporal relationship between COVID-19 and development of a dAVF with CVST. The effect of both COVID-19 and associated vaccines should be further assessed in future studies to examine its impact as an effect modifier on the association of dAVF and CVST.

Accuracy of unenhanced CT in the diagnosis of cerebral venous sinus thrombosis.

To evaluate the diagnostic performance of unenhanced brain CT (NECT) in identifying patients with cerebral venous sinus thrombosis (CVT). Forty-eight consecutive patients with CVT and 48 healthy controls were included in our retrospective study. All patients underwent NECT and CT/MR angiography within 24h. Two radiologists independently evaluated NECT images for the presence of sinus hyperdensity; discrepancies were solved by consensus. Sinus attenuation was measured in seven sites. The obtained data were compared with the presence of CVT at CT/MR angiography and with patients' hematocrit. Interobserver agreement in sinus hyperdensity detection was good (k = 0.64). The presence of sinus hyperdensity at NECT enabled to detect patients with CVT with 81% sensitivity, 77% specificity, 78% PPV, and 80% NPV. Mean attenuation was significantly higher in sinus segments involved by CVT than in patent ones (62.4 ± 10 versus 55.6 ± 6 HU, p < 0.0001). ROC analysis showed that a cutoff value of 63HU enables to detect patients with CVT with 52% sensitivity and 88% specificity. Hematocrit values were significantly correlated with patent sinus segments attenuation (r = 0.19). The presence of sinus hyperdensity at NECT enables to detect patients with CVT with 81% sensitivity and 77% specificity. A sinus attenuation cutoff value of 63HU can be used in order to increase specificity, but lowering sensitivity.

Radiological evaluation in patients with clinical suspicion of cerebral venous sinus thrombosis presenting with nontraumatic headache - a retrospective observational study with a validation cohort

BackgroundClinical suspicion of cerebral venous sinus thrombosis (CVST) is imprecise due to non-specific symptoms such as headache. The aim was to retrospectively assess the diagnostic value of nonenhanced CT (neCT) in patients with nontraumatic headache and clinically suspected CVST.MethodsA retrospective consecutive series of patients referred 2013–2015 for radiology were evaluated. Eligible patients had nontraumatic headache and suspicion of CVST stated in the referral, investigated with CT venography (CTV) and nonenhanced CT (neCT). neCT scans were re-evaluated for the presence of CVST or other pathology. All CTVs were checked for the presence of CVST. The validation cohort consisted of 10 patients with nontraumatic CVT (2017–2019).ResultsLess than 1% (1/104) had a suspected thrombus on neCT, confirmed by subsequent CTV. The remaining 99% had a CTV excluding CVST. Eleven percent had other imaging findings explaining their symptoms. In the patient with CVST, the thrombosed dural sinus was high attenuating (maximum HU 89) leading to the suspicion of CVST confirmed by CTV. The validation cohort (n = 10) confirmed the presence of a high attenuating (HU > 65) venous structure in the presence of a confirmed thrombus in all patients presenting within 10 days (suspicion written in referral, 10%).ConclusionsDespite clinical suspicion, imaging findings of CVST in nontraumatic headache are uncommon. Evaluating neCT for high attenuation in dural sinuses, followed by CTV for confirmation in selected cases seems reasonable. CVST should be recognized by all radiologists and requires a high level of awareness when reading neCT for other indications.

Sinovenous thrombosis associated with skull fracture in the setting of blunt head trauma

Emerging literature suggests that closed head injuries may be an important etiology of cerebral venous sinus thrombosis (CVST). Fractures over the dural sinuses, in particular, may predispose such patients to this secondary complication. The purpose of this study was to determine the incidence and characteristics of CVST resulting from skull fractures overlying cerebral venous sinuses at a single tertiary care center. A retrospective review of consecutive patients presenting to our institution with skull fractures from blunt head trauma between 1 January 2009 and 31 December 2011 who underwent either a computed tomography (CT) or magnetic resonance (MR) venogram. Patient demographics, associated intracranial injuries, admission Glasgow Coma Scale (GCS), presence of CVST, and post-hospital disposition were recorded. Overall, 908 patients with skull fractures presented to the institution. Of those, 63 had fractures over a sinus and a venogram satisfying inclusion criteria. Twenty-two (34.9%) patients demonstrated a thrombus in at least one sinus. There was no statistical difference in patient demographics, presenting GCS, length of stay (LOS), or outcome between patients with or without a thrombus. Pediatric patients had significantly shorter LOS (11 vs. 4days, p < 0.01) compared to adults. Adults had a greater incidence of total sinus occlusions while children had more non-occlusive thrombus formations; both were statistically significant (p = 0.035 and p = 0.037, respectively). This report suggests that over 10% of skull fractures involve cerebral venous sinuses, thus emphasizing the need to rule out CVST in patients suffering blunt head trauma. We propose including a venogram as part of the initial trauma work-up for these patients. Moreover, our data suggest that pediatric patients may be predisposed to less severe injuries than their adult counterparts.

Mutation in the Prothrombin Gene G20210A as a Cause of Cerebral Venous Thrombosis

Introduction. Cerebral venous sinus thrombosis (CVST) is a rare form of cerebrovascular disease, which may manifest clinically by a wide variety of signs and symptoms. It has been associated with multiple risk factors including genetic or acquired blood disorders, infections, and trauma. Case Report. Man of 17 years who presented with 10 days of intense global headache with nausea and vomiting and subsequent onset of mild hemiparesis and hypoesthesia in right hemibody. Studies show venous thrombosis of the superior longitudinal sinus. It was identified a gene mutation in prothrombin G20210A as a probable cause of the thrombosis. Conclusions. Substitution of guanine for adenine at nucleotide 20210 in the coding region of the prothrombin gene is the second most common primary thrombophilia. Multiple cases of CVST have been associated with this mutation. In the presence of CVST must be considered the primary studies for thrombophilia gene mutations, including prothrombin G20210A.

Unenhanced brain CT is useful to decide on further imaging in suspected venous sinus thrombosis

To assess the value of unenhanced brain computed tomography (CT) in the diagnosis of cerebral venous sinus thrombosis (CVST). Unenhanced brain CT images of 26 patients with proven CVST were mixed with 26 age and sex-matched images from patients without CVST. Four readers reviewed the 52 brain CT images and were asked to score the examinations for the absence or presence of CVST on a scale from 0 to 4. The mean density in the different venous sinuses was measured by one radiologist. The sensitivity of unenhanced brain CT for the diagnosis of CVST was 73%. There were no false-positive readings. A receiver-operating characteristic (ROC) analysis on these data resulted in an area under the curve of 0.86. Density measurements proved to be helpful, but could not detect all cases of CVST. Unenhanced brain CT is a valid initial radiological examination in the diagnosis of CVST. Due to the absence of false-positives in the present series, unenhanced CT can be used to decide whether further imaging with CT angiography or magnetic resonance angiography is required.