-What determines the range of clinical symptoms of CVST?
The location of the thrombosis and the collateral blood flow.
-The most common clinical symptom in patients with cerebral venous thrombosis is:
Headache (90%) (followed by Papilledema (45%) due to intracranial hypertension, Focal neurological deficits(40%), Seizures(37%), and Altered consciousness)
-What is the most common sinus affected?
SSS - Superior Sagittal Sinus (72-90%)
-From patients presentation can you note a possible cause?
Elevated hematocrit levels, Diabetes and AH are factors which favor Thrombocythemia.
Irregularly shaped hemorrhage in the right parietal lobe on the edge of white and gray mater. Parenchymal hemorrhage can be seen in one-third of cases of cerebral venous thrombosis.
Abnormal hyperattenuation consistent to direct visualization of a clot in the straight sinus on a non enhanced CT scan (Dense clot sign) (in 1/3 of cases)
Note the hyperdense presentation of SSS (Dense delta / filled triangle sign). This is not specific and can be observed occasionally in patients with an elevated hematocrit.
Contrast-enhanced CT image shows a central filling defect in the SSS, surrounded by intensely enhanced dura mater (Empty delta / empty triangle sign). It is seen in 25–52% of patients with sagittal, straight, and lateral sinus thrombosis.
View the difference on CT scan after 30 days
- CT (non-contrast):
- CT (C+):
- CT (C+):
- CT (non-contrast after 30 days):