Superior sagittal sinus thrombosis: subtle signs on neuroimaging

In 1825, Ribes described a case of a 45-year old man who died after a 6-month history of epilepsy, seizures and delirium. The autopsy examination revealed thrombosis of the superior sagittal sinus, the left lateral sinus and a cortical vein in the parietal region. This was probably the first detailed description of extensive cerebral venous sinus thrombosis (CVST). Since then, the literature describing this disease has comprised of case reports, series and some newer prospective studies, including recent reviews and guidelines (statement) on the diagnosis and management of CVST (Siddiqui & Kamal, 2006; Stam, 2005; Saposnik et al, 2011; Brown & Thore, 2011). The cerebral venous sinus thrombosis is a challenging condition and it is most common than previously thought. CVST accounts for 0.5% to 1.0% of all strokes and usually affects young individuals. Important advances have been made in the understanding of the pathophysiology of this vascular disorder. The diagnosis of CVST is still...

Bangladesh Journal of Medicine, 2023

Background: Cerebral sinus thrombus (CVST) is a rare form of stroke often affects young people with diverse clinical, etiological and radiological presentation. The aim of the study was to evaluate clinical relevance, etiologies, and imaging characteristics of CVST in Bangladesh. Methods: A prospective, observational study was done at a tertiary care hospital with patients recruited in the period of January 2021 to January 2023. 38 patients with clinical and radiological features suggestive of cerebral venous sinus thrombosis (CVST) were studied with thorough clinical evaluation and comprehensive work up. Results: The mean age of presentation was 28.42 years with female predominance (n = 24). Headache was the most common presenting symptoms (92%, n = 35) followed by vomiting (52%, n = 20). Hemi paresis (38%; n = 14) was the most common clinical sign followed by cranial nerve palsy (26%, n = 10). 31% of the patients (n=12) had provoked CVST among those the most common cause was found to be pregnancy/puerperium in 58% (n = 7 patients) followed by OCP which were 25% (n = 3). 69 % of the patients (n=26) had unprovoked CVST among those the most common cause was found to be prothrombotic conditions in 85% (n = 22 patients) followed by idiopathic which were 15% (n = 4). In magnetic resonance imaging venography (MRV), 74% of patients (n = 28) had thrombosis of transverse sinus, 53% of patients (n = 20) had thrombosis of the sigmoid sinus and 42% patients (n = 16) of patients had saggital sinus thrombosis. Conclusion: Clinical presentation is variable, etiology must be determined, and diagnostic method of choice is MRV. Headache was most the common clinical presentation and the most common etiological factor is puerperium. Provoked CVST is more common than unprovoked CVST and transverse sinus thrombosis frequently involved.

Neurology Asia

Objectives: To investigate the accuracy of multidetector computed tomography venography (MDCTV) and magnetic resonance venography (MRV) of differing fi eld strength in diagnosing cerebral venous sinus thrombosis (CVST). To assess the visualization rate of the cerebral veins and dural sinuses between these imaging modalities. Methods: A retrospective review of 27 patients with clinical suspicion of CVST who underwent both MDCTV and corresponding MRI/MRV brain scans at 0.35T, 1.5T or 3.0T fi eld-strength were performed. Results were compared with the defi nitive fi nal diagnosis. In the non-thrombotic group of patients, a descriptive study of the anatomical visualization of cerebral veins and dural sinuses was also undertaken. Results: Ten of the 27 patients had a fi nal diagnosis of CVST. The Neuroradiologists' consensus reading identifi ed these 10 cases of CVST in both the MDCTV and MRV scans with a sensitivity rate of 100%. There was one false positive in MDCTV and three false...

ijrrjournal.com/IJRR_Vol.6_Issue.9_Sep2019/Abstract_IJRR0030.html, 2019

Background: We undertook this study to analyze the demographic profile, frequency of different clinical features, risk factors, and prognostic outcome in patients suffering from cerebral venous thrombosis in our institution. Methods: We performed a retrospective descriptive-analytical study in which 50 patients with cerebral venous-sinus thrombosis, who referred to Department of Neurology, Government Kilpauk Medical College from January 2017 to March 2019, were included, and their demographic, etiologic(risk factors), clinical, radiological and prognostic characteristics were evaluated. Results: Out of 50 patients, there were 11 males (22%) and 39 females (78%); age ranged from 14 years to 72 years; headache was the most common symptom in 48/50 (96%), followed by paresis 23/50 (46%), seizures 22/50 (44%), papilledema 19/50 (38 %), mental status disorder 15/50 (30%), and aphasia 9/50 (18%). In majority of the patients 26 (52%), Pregnancy or Puerperium was the risk factor. The most common sinus involved was superior sagittal sinus(n-32), followed by almost equal involvement of transverse and sigmoid sinuses(n-29).Poor prognostic factors at the time of admission were stupor or coma (P=0.001) and parenchymal with or without subarachnoid hemorrhage in first CT scan. Conclusion: Sinus thrombosis remains a diagnostic challenge and a potentially disabling or lethal disease, but improved diagnosis by recent advances and treatment now result in an excellent outcome for most patients.

Stroke, 1986

The diagnostic value of the empty delta sign on post-infusion CT films was investigated in five patients with superior sagittal sinus thrombosis subsequently verified angiographically and/or pathologically. The empty delta sign, which has been considered to be unique and reliable in the diagnosis of cerebral venous sinus occlusion, was observed only on CT films taken one to four weeks after onset, and was not seen in the extremes of the acute or the chronic stage of the illness. These observations may explain why this sign has not been apparent in some reports concerning the CT findings of superior sagittal sinus thrombosis. Recanalization within the thrombus may be the reason why this sign was no longer apparent in the chronic stage of the patients with superior sagittal sinus thrombosis.

Journal of Neurosciences in Rural Practice, 2013

Cerebral sinus venous thrombosis (CSVT) is a rare phenomenon that can be seen with some frequency in young patients. CSVT is a multifactorial condition with gender-related specific causes, with a wide clinical presentation, the leading causes differ between developed and developing countries, converting CSVT in a condition characterized by a highly variable clinical spectra, difficult diagnosis, variable etiologies and prognosis that requires fine medical skills and a high suspicious index. Patients who presents with CSVT should underwent to CT-scan venography (CVT) and to the proper inquiry of the generating cause. This disease can affect the cerebral venous drainage and related anatomical structure. The symptoms may appear in relation to increased intracranial pressure imitating a pseudotumorcerebri. Prognosis depends on the early detection. Correcting the cause, generally the complications can be prevented. Mortality trends have diminished, and with the new technologies, surely it will continue. This work aims to review current knowledge about CSVT including its pathogenesis, etiology, clinical manifestations, diagnosis, and treatment.

Diagnostics

Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke that accounts for 0.5–1.0% of all strokes. Clinical presentation, predisposing factors, neuroimaging findings, and outcomes of CVST are extremely diverse, which causes a high index of suspicion in diagnosis. Therefore, early diagnosis of CVST is crucial for prompt treatment to prevent morbidity and mortality. Objective: The purpose of this prospective study is aimed at assessing the clinical characteristics, potential risk factors, and neuro-radiological features along with the topography of venous sinus involved in CVST patients in a tertiary care hospital, Lahore, Pakistan. Material and Methods: Consecutive patients enrolled in this study had a computed tomography (CT) scan, magnetic resonance imaging (MRI), and magnetic resonance venography (MRV) along with a clinical presentation to confirm the diagnosis of CVST. Categorical data were presented as percentages. Continuous variable and categorical data were compared...

Journal of Evidence Based Medicine and Healthcare, 2015

Neurosurgical Focus, 2009

C erebral venous sinus thrombosis constitutes a rare but serious cerebrovascular disorder, which was first reported in the literature more than 100 years ago. The clinical evolution of this entity and its natural history differ significantly from the various subtypes of arterial stroke, while its clinical presentation is characterized by a wide spectrum of symptoms and signs, depicted in an increasing body of previously published studies. The initial reports concerning CVST, which were based on autopsy series, led to the underestimation of the actual incidence of CVST. 2 More recently, the evolution of noninvasive diagnostic imaging methodologies such as CT angiography and venography, as well as MR imaging, angiography, and venography, enriched our knowledge regarding the full clinical spectrum of CVST and provided us with a more accurate estimation of its true incidence. The purpose of the current study is to review the pertinent literature concerning the most recent demographic data, current pathophysiological mechanisms, predisposing conditions, and the etiological factors to outline the recent advances in the early diagnosis and the prompt management of CVST.

Journal of Clinical Neuroscience, 2017

Recanalization and prognosis of cerebral venous sinus thrombosis (CVST) are generally considered to be good, and various factors have been reported to be associated with recanalization in previous studies. Fifty patients diagnosed with CVST between September 2007 and July 2016 were analyzed retrospectively. Modified Rankin scale (mRS) scores at six months and results of follow-up imaging of patients with at least six months follow-up were also reviewed for the assessment of long term outcome, recanalization rates and factors associated with recanalization. The mean age of the patients (39 female, 11 male) was 34.6 ± 11.2 years (17-69). Of the 50 patients enrolled, 31 (62%) had at least six months follow-up with available data and 26 (83.9%) of these had favorable outcomes (mRS 0-1) at six months. Complete recanalization was observed in 15 patients (48.4%), partial recanalization in 14 (45.2%) and no recanalization in 2 (6.5%). Univariate analysis revealed that complete recanalization rates were higher in female patients (p = 0.013) and lower in patients with multiple thrombosis in more than one dural sinus (p = 0.03). The prognosis and recanalization rates of CVST were good, and complete or partial recanalization of venous sinuses was not associated with clinical outcome.