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Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting

La trombosi venosa cerebrale. Ruolo di TC, RM e angio-RM in emergenza

La radiologia medica volume 115, pages 313–325 (2010)Cite this article

Abstract

Purpose

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.

Materials and 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.

Riassunto

Obiettivo

La diagnosi di trombosi venosa cerebrale (TVC), patologia relativamente rara che predilige i giovani, causa dell’1%–2% degli stroke dell’adulto e che ha esordio clinico subdolo, è spesso difficile. Scopo del lavoro è valutare il ruolo di tomografia computerizzata (TC), risonanza magnetica (RM) e angiografia RM (angio-RM), in emergenza. Vengono inoltre presi in considerazione fattori di rischio, tipo di presentazione clinica, outcome e follow-up.

Materiali e metodi

Abbiamo svolto uno studio retrospettivo su 40 pazienti con TVC, esaminati in urgenza nel periodo 1996–2006, con TC basale dell’encefalo ed esame RM e angio-RM; 14/40 pazienti hanno espletato angiografia digitale (DSA).

Risultati

La cefalea era il sintomo d’esordio predominante (60% dei casi). La TC basale ha evidenziato segni tipici (cord o delta sign) in 11 casi, negli altri era negativa o rilevava reperti aspecifici. La diagnosi è stata formulata con RM e angio-RM in 38/40 casi (95%); in 2/40 con DSA. Tutti i pazienti sono stati trattati con terapia anticoagulante. Cinque pazienti sono deceduti; degli altri solo uno è andato incontro a disabilità grave.

Conclusioni

La conoscenza dei segni TC, RM e angio-RM di TVC è essenziale per la diagnosi precoce della malattia e consente di formulare la diagnosi nella grande maggioranza dei casi, permettendo di intraprendere con tempestività il trattamento con farmaci anticoagulanti. Il ricorso alla DSA va riservato solo ai casi dubbi.

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Authors and Affiliations

  1. S.C. Radiodiagnostica, Università e A.S.O San Giovanni Battista, C.so Bramante 90, 10100, Torino, Italy

    L. Rizzo, S. Greco Crasto, E. Tola, D. Garabello & R. De Lucchi

  2. Servizio di Neuro-oncologia Clinica, Università e A.S.O San Giovanni Battista, C.so Bramante 90, 10100, Torino, Italy

    R. Rudà

  3. S.C. Neurologia, Università e A.S.O San Giovanni Battista, C.so Bramante 90, 10100, Torino, Italy

    G. Gallo

Authors
  1. L. Rizzo
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  2. S. Greco Crasto
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  3. R. Rudà
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  4. G. Gallo
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  5. E. Tola
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  6. D. Garabello
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  7. R. De Lucchi
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Correspondence to L. Rizzo.

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Rizzo, L., Crasto, S.G., Rudà, R. et al. Cerebral venous thrombosis: role of CT, MRI and MRA in the emergency setting. Radiol med 115, 313–325 (2010). https://doi.org/10.1007/s11547-010-0493-4

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  • DOI: https://doi.org/10.1007/s11547-010-0493-4

Keywords

  • Venous cerebral thrombosis
  • Dural sinuses
  • Magnetic resonance imaging
  • Magnetic resonance angiography

Parole chiave

  • Trombosi venosa cerebrale
  • Seni durali
  • Risonanza magnetica
  • Angio-RM