Early detection of cerebral venous thrombosis is crucial to decrease morbidity and mortality. In the presence of clinical suspicion directing early to specific angiographic imaging, the radiologist mission sounds to be not that difficult. The more challenging scenario happens if there is no clinical suspicion about venous thrombosis, and a routine non-enhanced CT or MRI was done.

Here are some helpful tips:

• T2 GRE/ SWI should be included in the routine protocol of any MRI of the brain
• vascular assessment should be done routinely in conventional MRI of the brain. For arteries, T2 is the best while for veins it is a bit more difficult requiring assessment in T1, T2, and T2 GRE/SWI trying to catch a significant signal alteration or blooming
• T2 GRE/SWI is sensitive to the paramagnetic effect of deoxyhemoglobin and hemosiderin 
• in acute venous thrombosis, the clot elicits a low signal in T2 that is a major trap giving a false impression of a normal venous sinus that is acutely thrombosed. T2 GRE/ SWI is very helpful in this context