Hospital: Complejo Asistencial Universitario de León.
Ciudad:
Nº:
Aut@r o Autores: A. Pérez Termenón, M. Pérez Rodríguez, I.M. López García, F.J. Somalo Alfaro, C. Rodríguez Morejón, A.M. Fernández Martínez.,
Presentación:
A 44 year-old woman appeared in emergency department suffering tonic-clonic convulsive crisis. She presented headache and hypertensive crisis during last 3 days. She was taking contraceptive pills.An unenhanced head computed tomography (CT) showed subarachnoid hemorrhage (SHA) in right cerebral convexity and hyperdensity on right transverse sinus with the form of a venous structure. The CT also proved a frontal left infarct with an area of hemorrhage and edema. The enhanced contrast CT demonstrated an intraluminal filling defect in right transverse and longitudinal sinuses proving vessel occlusion.
Discusión:
Cerebral venous thrombosis is a neurological disorder with variable clinical manifestations and etiologies, that makes it difficult to diagnose and demands high suspicius index.It presents with a wide spectrum of symptoms: neurological focal signs, headache (90%), seizures (40%), changes in mental state, vomiting…Unenhanced CT represents first radiological exploration for the evaluation of patients with neurological symptoms. It is normal in 70% of the patients affected by cerebral venous thrombosis.To diagnose it, we can help of direct and indirect radiological signs: – Direct signs: We visualized the thrombus in the vessel. o The “string sign” (20% of patients) is showed in the unenhanded CT as an hyperdense image following the vessel. o The “dense triangle sign” represents opacification from fresh coagulated blood. o The “empty delta sign” is showed in the contrast CT and it is produced due to an intraluminal filling defect. – Indirect signs: It shows brain parenchyma damage from ischemia or vascular changes (subcortical infarct) and haemorrhage complications. There are potencial pitfalls: on unenhanced CT, haemmoconcentration or parcial volumen artefacts, and on contrast-enhanced CT, arachnoid granulations and venous anatomic variants (aplasia or hypoplasia).The treatment are anticoagulants.
Conclusión:
Cerebral venous thrombosis is a neurological disorder with variable clinical manifestations and etiologies, that makes it difficult to diagnose and demands high suspicius index.It presents with a wide spectrum of symptoms: neurological focal signs, headache (90%), seizures (40%), changes in mental state, vomiting…Unenhanced CT represents first radiological exploration for the evaluation of patients with neurological symptoms. It is normal in 70% of the patients affected by cerebral venous thrombosis.To diagnose it, we can help of direct and indirect radiological signs: – Direct signs: We visualized the thrombus in the vessel. o The “string sign” (20% of patients) is showed in the unenhanded CT as an hyperdense image following the vessel. o The “dense triangle sign” represents opacification from fresh coagulated blood. o The “empty delta sign” is showed in the contrast CT and it is produced due to an intraluminal filling defect. – Indirect signs: It shows brain parenchyma damage from ischemia or vascular changes (subcortical infarct) and haemorrhage complications. There are potencial pitfalls: on unenhanced CT, haemmoconcentration or parcial volumen artefacts, and on contrast-enhanced CT, arachnoid granulations and venous anatomic variants (aplasia or hypoplasia).The treatment are anticoagulants.
Bibliografía:
– Bonneville F. Imaging of cerebral venous thrombosis. Diagnostic and interventional imaging 2014, 95(12), 1145-1150. – Linn J, Brückmann H. Cerebral Venous ans dural sinus thrombosis: State of the Art Imaging. Clin Neuroradiol 2010, 20(1), 25-37