The best diagnostic clue is demonstrating hyperdensity of the veins themselves, often associated with extension of the clot in the vein of Galen and into the straight sinus (see dural venous sinus thrombosis).
Typically the thalami are bilaterally oedematous with potential superimposed venous infarction and haemorrhage, although occasionally the findings will be markedly asymmetric or unilateral 3. For unknown reasons the right side is more often involved than the left when the involvement is asymmetric or unilateral.
Any age however women on the contraceptive pill are over represented.
Presentation is highly variable, but compared to run-of-the-mill dural venous sinus thrombosis is usually shorter and more rapidly progressive to profound deficit 3. Presentation can include: nausea, headache, focal neurological deficit, seizure, hemiparesis, aphasia, and coma.
- oral contraceptive pill (OCP) use
- prothrombotic conditions
- adjacent infection or inflammation
Please refer to the generic article for a more complete list: cerebral venous thrombosis.
Non-contrast CT, when not associated with venous haemorrhage or infarction can be a subtle finding, relying on hyperdensity of the ICV being identified.
With contrast administration, especially with a CT venogram, then a filling defect in the veins and sinuses is sought.
MRI is able to both visualize the clot as well as the sequelae.
- T1: The acute clot is isointense becoming hyperintense in the subacute phase; see ageing blood on MRI
- T2: acute clot is hypointense on T2 (this can mimic a flow void)
- MR venography: will demonstrate lack of flow.
Treatment and prognosis
For general discussion on treatment please refer to the parent article: cerebral venous thrombosis.
Compared to dural venous sinus thrombosis, deep cerebral venous thrombosis, especially when the internal cerebral veins are involved, carries a poorer prognosis 3.
- 1. Rodallec Mathieu H., Alexandre Krainik, Antoine Feydy et al. “Cerebral Venous Thrombosis and Multidetector CT Angiography: Tips and Tricks.” Radiographics 26, no. suppl_1 (October 1, 2006): S5-18. doi:10.1148/rg.26si065505.
- 2. Ferro Jose M., Patricia Canhao, Jan Stam et al. “Prognosis of Cerebral Vein and Dural Sinus Thrombosis: Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT).” Stroke 35, no. 3 (March 1, 2004): 664-670. doi:10.1161/01.STR.0000117571.76197.26.
- 3. Herrmann Karin A., Bernd Sporer and Tarek A. Yousry. “Thrombosis of the Internal Cerebral Vein Associated with Transient Unilateral Thalamic Edema: A Case Report and Review of the Literature.” AJNR Am J Neuroradiol 25, no. 8 (September 1, 2004): 1351-1355. [Link].
Synonyms & Alternative Spellings
|Synonyms or Alternative Spelling||Include in Listings?|
|Deep vein thrombosis - cerebral||✗|
|Deep brain vein thrombosis||✗|