title: Cerebral sinovenous thrombosis after closed head injury.
abstract: BACKGROUND
  Cerebral sinovenous thrombosis (CSVT) after closed head injury is an uncommon but potentially serious complication. The aim of this study was to determine whether diffusion weighted imaging (DWI) provide predictive information regarding prognosis.
  
  
  METHODS
  We retrospectively reviewed a series of 11 patients with CSVT after closed head injury. Each patient underwent computed tomography and magnetic resonance imaging within 24 hours of onset of symptoms, including DWI, magnetic resonance venography, and conventional sequences. Apparent diffusion coefficient (ADC) values were measured in seven regions of interest in 7 of 11 patients using DWI. Follow-up imaging and clinical outcome were assessed 6 months or later after initial presentation.
  
  
  RESULTS
  The most affected sinus was the posterior portion of the superior sagittal sinus. There was a mean time interval of 4.1 days between subsequent venous stroke and the initial insult. Brain edema improved in 6 of 11 patients on follow-up imaging. Six of 11 patients recovered successfully, although high or mixed DWI intensity associated with moderately decreased ADC (0.53-0.57 x 10(-3) mm2/s). Two other patients with hematomas developed venous infarction, despite mixed DWI with heterogeneous ADC value (0.55-1.11 x 10(-3) mm2/s). The other three patients, with high DWI and strongly decreased ADC values (0.26-0.27 x 10(-3) mm2/s), developed severe brain atrophy after superior sagittal sinus thrombosis.
  
  
  CONCLUSIONS
  The prospective cutoff point of ADC value may be higher in CSVT after head injury with traumatic hematoma. The territory of venous infarction was found to be larger in infants after treatment failure. In infants, CSVT can demonstrate initially cytotoxic brain edema, which is reversible with anticoagulation therapy.
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, Minamiku, Hiroshima, Japan. teruteru728@yahoo.co.jp
authors.forename: Toshinori
authors.initials: T
authors.lastname: Matsushige
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Nakaoka
authors.forename: Katsuzo
authors.initials: K
authors.lastname: Kiya
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Takeda
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
mesh_terms: D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D016489:Head Injuries, Closed / Q000150:complications*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult