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Research ArticleBrain

Parenchymal Abnormalities Associated with Cerebral Venous Sinus Thrombosis: Assessment with Diffusion-Weighted MR Imaging

Mark E. Mullins, P. Ellen Grant, Bing Wang, R. Gilberto Gonzalez and Pamela W. Schaefer
American Journal of Neuroradiology November 2004, 25 (10) 1666-1675;

Article Figures & Data

Figures

  • Fig 1.
    Fig 1.

    Patient 12. A 43-year-old woman with headache, blurred vision, and mental status change.

    A, T2-weighted axial MR image shows bilateral centrum semiovale hyperintense foci (arrows).

    B, On axial echo-planar DW image, the lesions (arrows) are hyperintense.

    C, On axial ADC map, the lesions (arrows) are hypointense.

    D, Follow-up axial CT scan shows low-attenuation foci (arrows), corresponding to the abnormalities on initial MR images, that are consistent with infarct.

  • Fig 2.
    Fig 2.

    Patient 9. A 31-year-old man with mental status changes and seizure activity.

    A, T2-weighted axial MR image shows bilateral frontal and right parietal hyperintense foci (arrows).

    B, On axial DW image, the lesions (arrows) are hyperintense.

    C, On axial ADC map, the lesions (arrows) are hypointense.

    D, Follow-up T2-weighted axial MR image shows no abnormality in the bilateral frontal and right parietal regions (arrows), consistent with interval resolution of the previous abnormalities.

  • Fig 3.
    Fig 3.

    Patient 4. A 25-year-old woman with headache and left-sided weakness.

    A, FLAIR axial MR image shows a right parietal T2 hyperintense focus (arrow).

    B, On axial echo-planar DW image, the lesion (arrow) is slightly hyperintense.

    C, On axial ADC map, the lesion (arrow) is hyperintense.

    D, Follow-up FLAIR axial MR image shows no abnormality, consistent with interval resolution of the previous abnormality.

  • Fig 4.
    Fig 4.

    Patient 5. A 24-year-old woman with headache and left-sided sensory loss.

    A, T2-weighted axial MR image shows central (arrowhead) and peripheral (arrow) right thalamic T2 hyperintense foci.

    B, On axil echo-planar DW image, the central lesion (arrowhead) is hyperintense and the peripheral lesion is isointense (arrow).

    C, On axial ADC map, the lesions are hypointense (arrowhead) and hyperintense (arrow), respectively.

    D, Follow-up CT scan shows central right thalamic infarct (arrowhead) and no abnormality in the peripheral region (arrow).

Tables

  • TABLE 1:

    Demographic data in 13 patients with CVT stroke

    Patient No./Age/SexInitial SymptomsVenous SinusesIntravenous TherapyCVT CauseStatus at DischargeSeizure
    1/71/FUnresponsive.Superior sagittal, L transverse.HeparinUnknownDiedNo
    2/34/FHeadache, confusion, R upper extremity weakness, behavior change, fatigue, somnolence.Superior sagittal.HeparinLupus, vitamin B12 deficiencyNormalYes
    3/39/ML Hemiplegia, headache, nausea.Superior sagittal, B transverse, R straight, R cortical.Heparin, urokinaseUnknownSlight L facial droop, upper extremity weakness, pronator drift.Yes
    4/25/FHeadache, L upper extremity weakness.Superior sagittal, R transverse.HeparinOral contraceptivesImproved headache, weakness resolved.No
    5/24/FHeadache.Superior sagittal, B deep.HeparinUnknownUnknownNo
    6/30/FHeadache, L hand weakness, memory and speech difficulties.Superior sagittal straight, R transverse, R internal cerebral.Urokinase, heparinMetastatic choriocarcinomaResolvedYes
    7/52/FHeadache, L hand and facial weakness, speech difficulties.Superior sagittal, R sigmoid, R transverse, R jugular vein.HeparinUnknownResolvedNo
    8/49/MHeadache, nausea, disorientation, speech difficulties, urinary incontinence.R transverse, R sigmoid, R straight, R internal cerebral, VOG.HeparinFactor V LeidenSpeech difficulties and disorientation improved, remaining symptoms resolved.No
    9/31/MSeizure, headache, L weakness.Superior sagittal, R transverse.Urokinase, HeparinDehydration, TB mastoiditisL weakness improved, headache resolved.Yes
    10/17/FHeadache, fatigue, nausea, confusion, L hemiparesis.Inferior sagittal, B straight, B deep.HeparinDehydration, oral contraceptivesL weakness improved, other symptoms resolved.No
    11/67/MHeadache, speech and vision difficulties.Superior sagittal, R transverse.Heparin, Lovenox (SC)DehydrationL field cut persisted, other symptoms resolved.No
    12/43/FHeadache, visual difficulties, decreased mental acuity, vague paresthesias.Superior sagittal, R straight, R transverse, R jugular vein.HeparinHyperviscosityDiedNo
    13/41/ML arm numbness and weakness.R cortical veins.HeparinUnknownWeakness improved.No

    • Note.—B indicates bilateral; L, left; R, right; SC, subcutaneous; TB, tuberculosis; VOG, vein of Galen.

  • TABLE 2:

    Imaging data in 13 patients with CVT stroke

    Patient No.Lesion LocationsAnatomic InvolvementT2WIDWIADCADC Mean (×10−3 mm2/s)Follow-up MR or CTHemorrhageFollow-up Sinus Patency
    11. B occipitalG/WHyperintenseHyperintenseHypointenseNot doneNot doneNoNot done
    2. CerebellumG/WHyperintenseHyperintenseHypointenseNot done
    3. B frontalG/WHyperintenseHyperintenseHypointenseNot done
    4. B parietalG/WHyperintenseHyperintenseHypointenseNot done
    21. L frontalG/WHyperintenseHyperintenseHypointense0.54306Resolution (MR)NoNo change
    2. R frontalG/WHyperintenseHyperintenseHypointense0.55513Resolution (MR)
    31. R parietal (central)G/WHypointenseHypointense (susceptibility)Hypointense (hemorrhage)Not doneHemorrhage (MR)YesNo change
    2. R parietal (peripheral)G/WHyperintenseIsointenseHyperintense1.6038Resolution (MR)
    41. R frontal (central)G/WHypointenseHypointense (susceptibility)Hypointense (hemorrhage)Not doneHemorrhage (MR)YesRecanalized
    2. R frontal (peripheral)G/WHyperintenseHyperintenseHyperintense1.0605Resolution (MR)
    3. R parietalG/WHyperintenseIsotenseHyperintense1.5659Resolution (MR)
    51. R thalamus (central)DGHyperintenseHyperintenseHypointense0.43744Infraction (CT)NoRecanalized
    2. R. thalamus (peripheral)DGHyperintenseIso/HyperintenseHyperintense1.075Resolution (CT)
    61. R thalamusDGHyperintenseHyperintense IsotenseHypointense (central)0.45055Infarction (MR)NoRecanalized
    2. R thalamusDGHyperintenseHyperintense1.204Resolution (MR)
    3. R putamenDGHyperintenseHyperintenseHyperintense (peripheral)0.41378Resolution (MR)
    4. L thalamusDGHyperintenseHyperintense0.47527Resolution (MR)
    5. L frontalG/WHyperintenseHyperintenseHypointense0.42851Resolution (MR)
    6. L caudateDGHyperintenseHyperintenseHypointense0.44393Resolution (MR)
    7. L putamenDGHyperintenseHypointense0.39336Resolution (MR)
    7R parietalG/WHyperintenseHyperintenseHyperintenseNot doneResolution (MR)NoRecanalized
    81. R thalamus (central)DGHypointense (hemorrhage)Hypointense (susceptibility)HypointenseNot doneHemorrhage (MR)YesRecanalized
    2. R thalamus (peripheral)DGHyperintense (edema)HyperintenseHyperintense1.0134Resolution (MR)
    3. L thalamusDGHyperintenseHyperintenseHyperintense0.89987Resolution (MR)
    4. R corona radiataWHyperintenseHyperintenseHyperintense0.88926Resolution (MR)
    91. R frontalG/WHyperintenseHyperintenseHypointense0.2545Resolution (MR)NoRecanalized
    2. L frontalG/WHyperintenseHyperintenseHypointense0.15438Resolution (MR)
    3. L parietalWHyperintenseHyperintenseHypointense0.25045Resolution (MR)
    101. R thalamus (central)DGHyperintenseHyperintenseHypointenseNot doneHemorrhage (MR) Resolution (MR)YesNo change
    2. R thalamus (peripheral)DGHyperintenseIso/hyperintenseHyperintenseNot doneInfarction (MR)
    3. L thalamusDGHyperintenseHyperintenseHypointenseNot done
    111. R centrumWHyperintenseHyperintenseHypointenseNot doneNot doneNoNot done
    2. R temporalG/WHyperintenseIsotenseHyperintenseNot done
    3. R occipitalG/WHyperintenseIsotenseHyperintenseNot done
    12R centrumG/WHyperintenseHyperintenseHypointense0.56893Infarction (MR)NoNo change
    L centrumG/WHyperintenseHyperintenseHypointense0.54106Infarction (MR)
    13L frontalG/WHyperintenseHyperintenseHypointenseNot doneNot doneNoNot done

    • Note.—B indicates bilateral; CT, nonenhanced CT with CT venography; DG, deep gray; DWI, diffusion-weighted imaging; G, gray matter; G/W, gray and white matter; L, left; MR, MR imaging; R, right; T2WI, T2-weighted imaging; W, white matter.

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Parenchymal Abnormalities Associated with Cerebral Venous Sinus Thrombosis: Assessment with Diffusion-Weighted MR Imaging
Mark E. Mullins, P. Ellen Grant, Bing Wang, R. Gilberto Gonzalez, Pamela W. Schaefer
American Journal of Neuroradiology Nov 2004, 25 (10) 1666-1675;
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