Cerebral venous sinus thrombosis CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kalsang Dolma, M.B.B.S.[2]

CT

• Cerebral edema and venous infarction may be apparent.
• The classic finding of sinus thrombosis on unenhanced CT images is a hyperattenuating thrombus in the occluded sinus; however, hyperattenuation is present in only 25% of sinus thrombosis cases.
• Increased attenuation in the venous sinuses also may be seen in patients with dehydration, an elevated hematocrit level, or a subjacent subarachnoid hemorrhage or subdural hematoma.

Patient #1:Thrombosis of multiple sinuses

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CT venography

For the detection of the thrombus itself, the most commonly used tests are computed tomography (CT) and magnetic resonance imaging (MRI), both using various types of radiocontrast to perform a venogram. Computed tomography, with radiocontrast in the venous phase (CT venography or CTV), has a detection rate that in some regards exceeds that of MRI. The test involves injection into a vein (usually in the arm) of a radioopaque substance, and time is allowed for the bloodstream to carry it to the cerebral veins - at which point the scan is performed. It has a sensitivity of 75-100% (it detects 75-100% of all clots present), and a specificity of 81-100% (it would be incorrectly positive in 0-19%). In the first two weeks, the "empty delta sign" may be observed (in later stages, this sign may disappear).

Cerebral angiography

Cerebral angiography may demonstrate smaller clots, and obstructed veins may give the "corkscrew appearance".