Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting.
OBJECTIVE
It is often difficult to diagnose cerebral venous thrombosis (CVT), an uncommon condition that more frequently affects young subjects, is responsible for 1%-2% of strokes in adults and has a subtle clinic onset. The aim of this study was to evaluate the role of computed tomography (CT), magnetic resonance imaging (MRI) and MR venography in the emergency setting and to discuss the risk factors, clinical presentation, outcome and follow-up of this disease.


METHODS
We retrospectively studied 40 patients with CVT admitted to the emergency department between 1996 and 2006 and examined with unenhanced CT, MRI and MR venography. Fourteen patients also underwent digital subtraction angiography (DSA).


RESULTS
Headache was the most common presenting feature (60%). Unenhanced CT showed typical signs (cord or empty delta sign) in 11 cases and nonspecific signs in the other cases. The diagnosis was achieved with MRI and MR venography in 38/40 cases (95%) and with DSA in 2/40 cases. All patients were treated with heparin. Five patients died, and only one of the remaining patients developed serious disability.


CONCLUSIONS
Knowledge of the CT, MRI and MR-venography signs of CVT is crucial and enables an early diagnosis and timely treatment with heparin in the majority of cases. DSA should be reserved for doubtful cases only.
Rizzo
L
L
S.C. Radiodiagnostica, Università e A.S.O San Giovanni Battista, C.so Bramante 90, 10100, Torino, Italy. lrizzo@sirm.org
Crasto
S Greco
SG
Rudà
R
R
Gallo
G
G
Tola
E
E
Garabello
D
D
De Lucchi
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D002533:Cerebral Angiography; D003287:Contrast Media; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D020767:Intracranial Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy
D000925:Anticoagulants; D003287:Contrast Media; D006493:Heparin