Figure 1
Thrombosis
Sagittal, 3D-PC image reveals nonfilling of the anterior parts of the superior sagittal sinus.
Clinical History
Acute neurologic deterioration
Imaging Findings
The patient presented with acute neurologic deterioration with nonspecific clinical signs and symptoms. A CT scan was normal, and the patient was referred to MRI two days later. On MRI an impression of high signal was noted in the anterior portions of superior sagittal sinus. MR angiography, and diffusion MRI were obtained.
Discussion
Venous sinus thrombosis most commonly involves the superior sagittal sinus, and can result in petechial hemorrhages and venous infacts. A variety of disease processes including dehydratation, infection, trauma, hematologic disorders, and others may cause venous sinus thrombosis. In some cases, however, no cause can be identified. In cases with prominent changes associated with venous sinus thrombosis, an empty delta sign on CT, and an hyperintense sinus are usually noted in the subacute phase. In the acute phase, however, a CT scan may be normal, and changes on MRI may be equivocal. Complications (petechial hemorrhages and venous infacts) are best identified on MRI. MR angiography can reveal occluded parts of the sinus. On diffusion MRI venous infarcts are usually well demonstrated. Apparent diffusion coefficient (ADC) maps can reveal the thrombus itself, as well as associated changes as demonstrated in the current case. The cause of thrombosis was unclear in this patient. The clinical outcome was good with thrombolytic therapy.
Differential Diagnosis List
Thrombosis, petechial hemorrhage, venous infaction
Final Diagnosis
Thrombosis, petechial hemorrhage, venous infaction
References
[1]
Keller E, Flacke S, Urbach H, Schild HH. Diffusion- and perfusion-weighted magnetic resonance imaging in deep cerebral venous thrombosis.
Stroke. 1999 May;30(5):1144-6. (PMID: 10229757)
[2]
Corvol JC, Oppenheim C, Manai R, Logak M, Dormont D, Samson Y, Marsault C, Rancurel G. Diffusion-weighted magnetic resonance imaging in a case of cerebral venous thrombosis.
Stroke. 1998 Dec;29(12):2649-52. (PMID: 9836780)
Case information
| URL: | https://eurorad.org/case/649 |
| DOI: | 10.1594/EURORAD/CASE.649 |
| ISSN: | 1563-4086 |
Figure 2
ADC maps of diffusion MRI
ADC map shows the thrombus (white arrow). Its ADC value was 0.35 X 10-3 mm2/sec (ADC value of a normally flowing venous sinus is zero). A focus of petechial hemorrhage is seen (black arrow) with an ADC value of zero (Acute and subacute hemorrhagic products, as well as hemosiderin usually have a ADC value of zero)
ADC map from a lower section again shows the thrombus (white arrow). A focus of venous infact with low signal, and surrounding edema with high signal is seen (arrows). The ADC value of infact was 0.44 X 10-3 mm2/sec (infacts usually have ADC values less than 0.60, and may be as low as 0.10 X 10-3 mm2/sec). ADC value of edema was 1.44 X 10-3 mm2/sec (ADC ranges of vasogenic edema are 1.28-2.20 X 10-3 mm2/sec)
Thrombosis
Sagittal, 3D-PC image reveals nonfilling of the anterior parts of the superior sagittal sinus.
ADC maps of diffusion MRI
ADC map shows the thrombus (white arrow). Its ADC value was 0.35 X 10-3 mm2/sec (ADC value of a normally flowing venous sinus is zero). A focus of petechial hemorrhage is seen (black arrow) with an ADC value of zero (Acute and subacute hemorrhagic products, as well as hemosiderin usually have a ADC value of zero)
ADC map from a lower section again shows the thrombus (white arrow). A focus of venous infact with low signal, and surrounding edema with high signal is seen (arrows). The ADC value of infact was 0.44 X 10-3 mm2/sec (infacts usually have ADC values less than 0.60, and may be as low as 0.10 X 10-3 mm2/sec). ADC value of edema was 1.44 X 10-3 mm2/sec (ADC ranges of vasogenic edema are 1.28-2.20 X 10-3 mm2/sec)