November-December 2016
Figure 4 from Maralani

An Update on Cerebral Venous Thrombosis

Thamburaj picture

Dr. Krishnamoorthy Thamburaj

From the days of limited knowledge through the autopsy series, imaging techniques have vastly expanded our understanding of almost every aspect of cerebral venous thrombosis (CVT), including demography, pathophysiology, clinical manifestations, treatment options, and outcome. CVT is responsible for only 0.5 to 1% of stroke; however, it is well known to pose a considerable challenge to diagnosis on clinical assessment and imaging.1 It is no surprise, then, that results from the largest cohort of CVT cases demonstrated a median delay of 4 days in admission to a hospital and 7 days in diagnosing CVT from the onset of symptoms.2 Fortunately, CVT carries a better prognosis in approximately 85% of cases and deep venous thrombosis is no exception.2,3 CVT carries mortality and significant morbidity in 13–15% of cases, which intensifies the need to recognize the condition at the initial presentation, initiate appropriate treatment measures, and improve the outcome.2

Anticipation of the diagnosis and a standard approach to analyze the cerebral venous structures on routine imaging are essential steps for a successful identification of CVT. Analysis should focus on recognizing as well as searching for connections between the direct signs of venous clot and the indirect signs of parenchymal changes, features of raised intracranial pressure, venous collaterals, dural thickening, etc. In emergent situations, the diagnosis of CVT is often unsuspected clinically and the patients typically undergo a head CT. Depending on the time of clinical presentation and location of the venous … more »