Ces radiol. 2007, 61(3):242-250

Intracranial venous thrombosis: diagnostic possibilities and clinical correlationOriginal article

Josef Vymazal¹, Jan Šroubek², Denisa Vondráčková³, Miroslav Kalina³

¹ Radiodiagnostické oddělení Nemocnice Na Homolce, Praha

² Neurochirurgické oddělení Nemocnice Na Homolce, Praha

³ Neurologické oddělení Nemocnice Na Homolce, Praha

Aim: To discuss the topic of intracranial venous thrombosis, and in particular thrombosis of the dural sinuses. Its infrequent occurrence, variable clinical symptomatology and the need to use special MR techniques, which make diagnosis difficult and sometimes late.

Methods: Eleven patients were admitted to Na Homolce Hospital (NHH) between 2005 and 2006 with a diagnosis of intracranial venous thrombosis (IVT). This number correlates with the statistical incidence for a specialized center. All patients underwent at least one MRI scan. 3D TOF, PC and standard MR imaging (non-contrast and contrast-enhanced) were employed. The detailed clinical history included information about hormonal contraception, any family history of thrombosis before the age of 40 and thrombophilic conditions in general. Detailed biochemical and genetic examinations to detect latent thrombophilic factors and mutation were employed.

Results and conclusion: The group of patients included 10 females and one male. Eight females used hormonal contraception at the time of the thrombosis. The average age was 33 years, range 19-50 years. One patient had undergone surgery two weeks before the event. The VIII coagulation factor was elevated in six patients while eight patients were heterozygotes for the MTHFR thrombophilic mutation. Leiden mutation was not detected. Clinically, headache was the most frequent symptom (7×) followed by an epileptic seizure (4×) and hemiparesis was present in three patients. MR proved the thrombosis of at least one sinus in all cases. The pitfalls involved in the diagnostics include anatomical variations of the venous system, imitation of the flow-void sign in T2-weighted images in acute thromboses, imitation of the flow in subacute thromboses (methemoglobin) in TOF angiographies. PC angiography plays an important role in these cases. Furthermore, slow and turbulent flow may imitate a partial or complete thrombosis.
Tissue complications include edema, stroke and red malatia or their combination. Some lesions may imitate brain tumors.

Keywords: MR angiography, risk factors, thrombosis of dural sinuses

Grants and funding:

Podpořeno grantem NR/8937-4/2006 IGA MZ ČR a výzkumným záměrem MŠMT ČR MSM 0021620849.

Accepted: July 10, 2007; Published: September 1, 2007  Show citation