Cerebral venous sinus thrombosis (CVST)

History: One-month-old girl with seizures

Findings: Axial noncontrast CT shows high density in the internal cerebral veins. Sagittal T1-weighted MR image demonstrates abnormal high signal within the internal cerebral veins and vein of Galen. No flow is present within the deep venous system on phase contrast magnetic resonance venography.

Cerebral venous sinus thrombosis (CVST) is the presence of acute thrombosis (a blood clot) in the dural venous sinuses, which drain blood from the brain. Symptoms may include headache, abnormal vision, any of the symptoms of stroke such as weakness of the face and limbs on one side of the body, and seizures.


Possible sites of cerebral venous thrombosis:

Discussion: Deep cerebral venous thrombosis is an uncommon disorder frequently resulting in severe neurological disability of death. Diagnosis and appropriate management are often delayed because of nonspecific clinical manifestations. This condition is most common in infants with dehydration or septicemia. Oral contraceptives, pregnancy, and hematologic disorders are etiologic factors associated with venous thrombosis in adults. Alteration in the level of consciousness with progression to a comatose state is the classic presentation in deep cerebral venous thrombosis. CT findings include hyperdense thrombus within the internal cereal veins, vein of Galen, or straight sinus on noncontrast studies. Hypodensity in the basal ganglia representing edema or infarction may also be see. Nonfilling of the deep cerebral veins with enlarged collaterals is present at angiography. MRI may be used as the definitive investigation, initially demonstration absence of flow within the affected venous structures. After several days, the thrombosed vessel becomes hyperintense on T1- and T2-weighted images as the thrombus becomes replete and with extracellular methemoglobin. Antithrombotic therapy is now considered to be safe and effective treatment, particularly when hemorrhage has not been demonstrated.

Aunt Minnie’s Pearls

  • Absence of flow and hyperintensity in the internal cerebral veins, vein of Galen, or straight sinus= deep cerebral venous thrombosos

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