Isolated inferior sagittal sinus thrombosis: a case report

We present a case of isolated inferior sagittal sinus thrombosis shown on CT, MRI and angiography. This condition has not, to our knowledge, been described previously. Received: 17 June 1996 Accepted: 13 August 1996     

Cases from the Cleveland Clinic: cerebral venous sinus thrombosis presenting to the emergency department with worst headache of life

A 31 year old woman presented with the worst headache of her life and was diagnosed with cerebral venous sinus thrombosis (CVST) by routine unenhanced computed tomography (CT) scan, subsequently confirmed with magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Awareness of this less common cause for acute neurological presentation in the Emergency setting is important; the imaging characteristics of CVST are reviewed.     

Quantitative assessment of the superior sagittal sinus on unenhanced computed tomography

Purpose

To determine the relationship between hemoglobin levels and attenuation measurements of the superior sagittal sinus (SSS) on unenhanced computed tomography (UECT). Secondly, to determine if SSS attenuation values are normally distributed such that measurements below and above certain thresholds are suggestive of pathology, such as anemia or acute venous thrombosis respectively.

Methods

Institutional review board approval was obtained for retrospective review of adult patients having both an UECT head examination and a complete blood count within 24 h of the scan. A cohort of 151 consecutive patients formed the study sample (76 males and 75 females, 17-91 years of age with a mean of 61). The dorsal aspect of the SSS was divided into upper, middle and lower segments. Using freehand and circle region of interest (ROI) techniques, a total of six attenuation measurements were obtained from each patient. Next, statistical analyses were preformed to assess the correlation between Hgb levels and attenuation values, and distribution curves were plotted to assess the normal range of SSS attenuation measurements.

Results

There is a moderate, yet statistically significant (p < 0.001), correlation between Hgb levels and attenuation values in upper, middle and lower segments of the SSS (r = 0.487, 0.497 and 0.533 respectively). Based on the calculated mean, median and mode, the attenuation values are normally distributed. When using the freehand ROI technique, the mean value is 50 Hounsfield Units (HU) with a standard deviation (SD) of 7.5. Attenuation values less than 2 SDs (35 HU) are highly suggestive of anemia (specificity and PPV = 100%).

Conclusion

There is a moderate, yet statistically significant, correlation between Hgb levels and attenuation of the SSS on UECT. Furthermore, attenuation measurements of the SSS are normally distributed with a mean of 50 HU and a SD of 7.5. Therefore, quantitative assessment of the SSS may prove useful in the clinical practice of a radiologist; namely, in the diagnosis of anemia and acute venous thrombosis.     

产后颅内静脉窦血栓形成6例临床与影像分析

目的 探讨产后颅内静脉窦血栓形成的发病机制、临床表现、影像学特点、诊断、鉴别诊断以及治疗。方法回顾性分析6例已确诊的产后颅内静脉窦血栓形成患者的临床与影像资料。结果6例患者临床均以亚急性高颅压症状为主，以上矢状窦血栓形成多见，在轴位T2WI上，窦腔内可见长T2高信号影，在矢状位T1WI上，窦腔内可见短T1高信号影。结论对于有妊娠和分娩史，不明原因出现颅内压增高、局限性神经症状、突然意识障碍的患者，须行头MRI或DSA检查。     

上矢状窦栓塞大脑髓静脉改变的SWI研究

目的:利用磁敏感加权成像(SWI)技术探讨上矢状窦栓塞后大脑髓静脉的改变。方法:对10例上矢状窦栓塞患者和年龄、性别相匹配的10例健康志愿者行常规MRI、MRV和SWI,应用计算机后处理软件对SWI图像进行处理,得到校正后的磁矩图和相位图,将大脑髓静脉增多扩张脑白质区作为病变组、其对侧镜像正常脑白质区为对照组1,健康志愿者与病变组相同位置脑白质区为对照组2,分别测量相位值,进行比较,统计学分析采用单因素方差分析。结果:病变组选择髓静脉增多扩张脑白质区37处测得相位值为-0.571～0.104,平均-0.051;对照组1相位值为-0.047～0.079,平均0.010;对照组2相位值为-0.045～0.056,平均0.014;病变组相位值低于对照组1和对照组2,差异有统计学意义(P<0.001);对照组1和对照组2相比,二者无显著差异(P=0.790)。结论:磁敏感加权成像(SWI)能明显显示上矢状窦栓塞患者大脑髓静脉的增多、扩张,并可利用相位信息为其提供量化依据。     

An arachnoid granulation in the straight sinus

We report CT, MRI and angiographic findings of an arachnoid granulation in the straight sinus in a young man. Its density and signal intensity were isodense and isointense with cerebrospinal fluid on CT and MRI, respectively. The lesion appeared as a filling defect on MR venography and conventional angiography. Received: 2 November 1999/Accepted: 3 February 2000     

颅内静脉窦血栓形成的MRI和MRV表现

目的探讨颅内静脉窦血栓形成的MRI和MRV（磁共振静脉成像）表现特点。方法回顾分析20例颅内静脉窦血栓形成患者的MRI和MRV表现。20例均行常规MRI,10例行MRI增强,15例行MRV检查（2DTOF）。结果20例常规MRI榆查中,12例静脉窦内正常流空效应消失,T1WI,T2WI和FLAIR静脉赛内见等、高或低信号,3例静脉宴内未见明屁异常信号但伴有腑组织水肿、出血、梗死及脑积水。5例海绵窦区T1WI见稍低或等信号,T2WI见高信号并可见强化．15例MRV见静脉窦高信号缺失、静脉窦粗细不规则、静脉窦内充盈缺损。结论MRI和MRV相互结合可有助于对顿内静咏窦血栓形成的早期作出正确诊断。     

Invasive aspergillosis presenting as a cavernous sinus mass in immuno competent individuals; report of 3 cases

Aspergillosis of the cavernous sinus is rare, especially in immuno competent individuals. We report three such cases secondary to paranasal sinus aspergillosis, with imaging findings. Received: 26 March 1998/Accepted: 28 January 1999     

旁路移植生物材料重建上矢状窦动物模型研究

目的建立比格犬上矢状窦旁路移植模型,探索利用此模型移植生物型材料重建上矢状窦的可行性。方法健康成年雄性比格犬8只,体重12.5～22.0kg,骨窗开颅暴露两侧上矢状窦并阻断后,在显微镜下行移植材料与上矢状窦的端-侧吻合,术后给予抗感染等对症处理。分别于移植后1、24、8、周进行上矢状窦造影和彩色多普勒检查(CDFI),8周时处死动物,行植入材料的组织学检查。结果术后上矢状窦造影和CDFI检查显示,8只犬中2只吻合口轻度狭窄、CDFI流速较高,1只吻合口有少许渗漏、CD-FI流速稍低,另5只上矢状窦造影及CDFI检查均无异常。8周后植入材料和上矢状窦吻合处均有内皮细胞生长,并向移植材料内爬行。结论成功建立了上矢状窦旁路移植模型,近期效果良好,但远期效果尚有待进一步观察。     

Giant arachnoid granulation mimicking dural sinus thrombosis in a boy with headache: MRI

We report MRI and angiographic findings of an unusual giant arachnoid granulation in the left sigmoid sinus in a boy with headache. Its signal intensity was lower than that of cerebral cortex on T1-weighted images and higher on T2 weighting, mimicking dural sinus thrombosis. Received: 17 February 1997 Accepted: 17 February 1997     

脑静脉窦血栓形成合并脑出血临床分析（附7例报告）

目的：探讨脑静脉窦血栓合并脑出血的临床诊断和治疗。方法：回顾分析2006年6月～2008年10月收治的7例脑静脉窦血栓合并脑出血患者临床资料。结果：7例患者中,3例入院时已经发生脑疝的患者行开颅血肿清除加去骨瓣减压,术后给予脱水、抗炎治疗,1周后其中2例给予抗凝治疗。4例未发生脑疝患者入院后给予脱水、抗炎、低分子肝素抗凝治疗。1例术后未血凝治疗男性患者半月后并发下肢深静脉血栓家人放弃治疗,自动出院,6例女性患者痊愈出院。结论：抗凝治疗可作为当前治疗脑静脉及脑静脉窦血栓的主要方法,即使在合并颅内出血的情况下,也常作为首选方式,但对于急性颅内高压,在脱水药物治疗无效情况下,手术清除血肿及去骨瓣减压也可作为一种治疗手段。     

Dural sinus thrombosis

Summary Magnetic resonance imaging has been reported to have advantages over conventional angiography in the diagnosis of dural sinus thrombosis. A case report is presented describing the application of MR techniques including MR angiography, to diagnose and monitor therapy for dural sinus thrombosis.     

脑静脉窦及深静脉血栓的CT、MRI诊断

目的:探讨脑静脉窦及深静脉血栓的CT和MRI表现及诊断价值。方法:回顾性分析17例脑静脉窦及深静脉血栓患者的CT和MRI表现特点。结果:CT表现为静脉窦密度略高信号增高、窦腔增宽(n=5/12),增强扫描可见“空三角”征(n=3/3);随着病程的改变,MRI可表现为静脉窦T1WI(n=15/17),T2WI(n=13/17)流空效应消失,磁共振静脉成像(MRV)及增强MRV可显示静脉窦闭塞及静脉窦内充盈缺损(n=17/17;n=4/4);CT及MRI还可见皮层及皮层下多发、散在的出血性脑梗塞(n=7/12;n=13/17),基底节区脑梗塞(n=3/12;n=4/17)等间接征象。结论:CT增强可以显示静脉窦血栓,MRI、MRV及增强MRV相结合能准确地诊断脑静脉窦及深静脉血栓,MRI优于CT平扫。     

Postpartum superior sagittal,left transverse sinus and right internal jugular vein thrombosis with left parietal infarct: A case report

Cerebral venous sinus thrombosis is a rarely occurring condition. Pregnancy and postpartum are both known risk factors for cerebral venous sinus thrombosis. Early detection and treatment are critical, as CVST can be potentially life-threatening. Here, we present a case of a patient who developed left transverse and superior sagittal sinus thrombosis 15 days after normal vaginal delivery. The patient presented to the emergency department with complaints of irritability and an altered state of consciousness for two days. The patient also developed seizures extending from the lower limb to the upper body. Laboratory investigations revealed abnormalities in the complete blood count report and urine complete examination. The patient''s coagulation profile was totally abnormal, indicating a presence of a thrombus. All the other diagnostic techniques, including Electrocardiogram, Carotid Doppler Scan, and Ultrasound abdomen, revealed no findings. However, Magnetic resonance venography + Magnetic resonance imaging showed partial superior sagittal sinus thrombosis in the anterior and upper parietal regions, right internal jugular vein thrombosis, and left transverse thrombosis with associated left parietal infarcts. The presence of thrombosis in sinuses and jugular vein resulted in seizures, altered state of consciousness, and other associated symptoms. The patient was treated with sodium valproate, heparin, and other medications accordingly. The above-mentioned case was unique due to the involvement of unusual sinuses (transverse sinus) as previous studies have only reported cases of thrombus presence in the superior sagittal sinus. This case study will discuss patient diagnosis and management with Heparin and Diazepam to stop altered state of consciousness and seizures in females.     

脑静脉窦血栓形成的MRI诊断

目的 :探讨MRI和MR血管成像 (MRA ,MRV)对脑静脉窦血栓形成 (CVST)的诊断价值。方法 :回顾性分析 10例CVST患者的临床和影像资料。全部病例行常规MRI和MRA( 3DTOF)、MRV( 2DTOF)检查 ,其中 9例行增强扫描。结果 :MR常规扫描示脑实质内均出现异常信号 ,仅 1例T2 WI未见异常信号 ,增强扫描 9例全部出现静脉异常强化。有 5例MRA除可见动脉正常显影外 ,还可见受累的静脉和静脉窦显影。MRV示栓塞的静脉窦不显影或显影欠佳。结论 :常规MRI结合MRA、MRV是诊断CVST的无创和有效手段     

MRI结合MRV对颅内静脉窦血栓的诊断价值

目的：探讨颅内静脉窦血栓的MRI及MRV诊断价值。方法：收集13例经临床证实的颅内静脉窦血栓患者,均做MRI及MRV检查,分析MRI及MRV在该病中的应用价值。结果：MRI平扫中见正常的静脉窦流空信号消失,增强MRI见空三角征,MRV见静脉窦闭塞。结论：MRI及MRV是颅内静脉窦血栓形成的最佳诊断手段。     

Hemangioma of the maxillary sinus: A benign and rare cause of epistaxis

Hemangioma of the facial sinuses is a rare pathology, and given the lack of clinical specificity, the differential diagnosis with a malignant lesion often arises. We report the case of a 32-year-old patient who consulted for recurrent epistaxis of moderate severity. The preoperative diagnosis of a hemangioma of the left maxillary sinus was based on computed tomography and magnetic resonance imaging data, confirmed by the anatomopathological study of the surgical specimen, preceded by an embolization that facilitated the endoscopic surgical excision.     

Multisegmental anomaly of the inferior vena cava with thrombosis of the left inferior vena cava

We present a rare case of an extensive venous thrombosis associated with a multisegmental anomaly of the inferior vena cava (IVC), double IVCs, a hypoplastic right IVC, an aneurysm arising at the distal portion of the right IVC, and a severe stenosis between the prerenal and the hepatic segments of the IVC.     

Recovery from primary deep cerebral venous sinus thrombosis with recanalisation

A 50-year-old woman with idiopathic deep cerebral sinus and vein thrombosis (DCVT) had cerebellar disturbance prior to impaired consciousness. CT and MRI revealed haemorrhagic infarction in the cerebellum and signal changes suggesting infarction in the thalamus and basal ganglia bilaterally. The straight sinus and internal cerebral vein (ICV) were dense on CT. On angiography, the vein of Galen (VG) and straight sinus were not seen. Following clinical recovery, CT and MRI became normal, and angiography showed recanalization of the VG and ICV. The relationship between cerebellar infarction and DCVT, and signal changes on CT and MRI are discussed.     

Paranasal sinus imaging

Endonasal surgery is currently extending its application beyond inflammatory sinonasal lesions to successfully treat both benign and malignant neoplasms. This progression has been possible by the detailed information provided by imaging techniques (CT, MRI and PET). Inflammatory diseases are the "domain" of CT. CT provides excellent details about the thin bony sinonasal walls separating the ethmoid from the anterior skull base and the orbit. Benign and malignant neoplasms are the "domain" of MRI because the tumor is more easily separated from adjacent structures, the periosteal linings (periorbita, dura mater) and perineural spread can be accurately shown. Whereas MRI precisely assess pre-treatment tumor extent, early submucosal local recurrences are difficult to demonstrate because of post-treatment changes of the anatomy and of the signal of treated tissues. Though diffusion-weighted imaging and dynamic contrast-enhanced techniques are promising developments, PET-CT may overcome the limits of morphological MRI.