Fact-sheet: Dural sinus thrombosis

Updated on 09/30/2019 at 4:38 PM

Note : 0/10

Definition

Thrombus of cortical veins, venous sinuses, or deep veins
1) Etiology: Multiple++

Predisposing conditions: genetic or acquired prothrombotic state, hematologic disease, malignancy, systemic and inflammatory disease
Precipitating factors: infection, pregnancy, contraceptives, postoperative state, central catheters, treatment (L-asparaginase)
Undetermined in 30% of cases

2) Natural history:

Variable onset: acute (30%) / subacute (50%) / chronic (20%)
Female predominance

Prognosis - Course:

Complete recovery without sequelae (60%)
Moderate to severe disability (5%)
Late complications: epilepsy (10%), recurrent thrombosis (5%), cerebral arteriovenous fistula

Spontaneous hyperdensity of the thrombus: "cord sign" or "dense triangle sign"
Cerebral CT venography: "empty delta sign"
Indirect signs: cerebral edema, intraparenchymal Hematoma, subarachnoid hemorrhage, ischemic lesions with suggestive topography (bithalamic, subcortical parietal)

Note: thrombus signal varies over time and according to the sequence used

T1 SE: loss of flow void, thrombus iso- to hyperintense
T2 FSE: thrombus hypo- to isointense in the acute stage, then hyperintense. Edema
T2 GRE: marked hypointensity – magnetic susceptibility effect. High sensitivity for cortical veins. Superior sensitivity with SWI
Diffusion: thrombus hyperintense. Predictive of poor recanalization (P. Favrole, Stroke 2004), ischemic lesions with decreased ADC
Post-contrast T1: volumetric acquisition. Intraluminal filling defect. MR venography preferred
MR venography (with or without contrast): defines the occlusion
Value of SWI imaging to increase sensitivity for thrombus visualization when not seen on T2*, particularly for cortical vein thrombosis

Parenchymal impact:

Venous infarction: corticosubcortical vasogenic edema not corresponding to an arterial vascular territory, complicated by hemorrhage in 50% of cases (typically a large area of edema with +/- limited central hemorrhagic transformation)
In deep venous system thrombosis = bilateral FLAIR hyperintensity (DWI = increased ADC) of the thalami +/- striatum
NOTE: unilateral involvement is possible: pseudotumoral appearance (-> consider deep venous thrombosis)
Intraparenchymal Hematoma or subarachnoid hemorrhage

X-Ray Angiography:

Antithrombotic treatment: Heparin ++ even in cases of hemorrhagic venous infarction
Symptomatic treatment: anti-epileptics, corticosteroids/edema
Etiologic treatment