Thrombosis of cerebral veins dural sinuses after paratyphi
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Neuroradiology
Neurological examination
Straight sinus
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Objective To evaluate the value of MRI,MRV and CT in the diagnosis of the dural venous sinus thrombosis. Methods Twenty patients with dural venous thrombosis were examined with spin echo MR imaging and MR venography (fifteen patients of them had been examined with CT). The abnormal signal of dural sinus,cerebral edema,cerebral parenchyma abnormal lesion and mastoid process inflammation was observed. Results In the fifteen patients of CT scan,cerebral parenchyma abnormal density lesion in 7 patients,enlarged and high density superior sagittal sinus in 1 case,superior sagittal sinus thrombosis in 11 cases,superior sagittal sinus with transverse sinus,straight sinus or sigmoid sinus thrombosis in 7 cases,left transverse with sigmoid sinus thrombosis in 1 case,and right sigmoid sinus thrombosis in 1 case were found respectively.Spin echo sequence show abnormal signal of intracerebral in eight patients,high signal in the superior sagitta sinus,transverse sinus and sigmoid sinus were showed in fourteen patients. Conclusion MR venography is the most valuable method in the diagnosis and following up of the dural venous sinus thrombosis,a high signal in the dural sinus can clue to this disease.In showing the edema and homorrhage,T1WI is better than T2WI. But in showing the mastoid process inflammation,T2WI is the best. So MRI plus MRA is superior to CT or DSA.
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Objective To explore the way of establishing porcine cerebral venous sinus thrombosis model by injection of thrombin via percutaneous transvenous method. Methods Six mini-pigs were performed percutaneous transvenous catheterization by Seldinger technique,and thrombin was injected into the cerebral venous sinus to induce thrombosis,which was then confirmed by digital subtraction angiography(DSA) immediately and 1 week later.MRI examinations were performed 1,3 and 7 days after the procedure,and the pigs were sacrificed for gross and histological examinations.Results The models of cerebral venous sinus thrombosis were successfully established in all the pigs,including 3 cases in superior sagittal sinus,2 cases in superior sagittal sinus accompanied with left transverse sinus and sigmoid sinus and 1 case in left transverse sinus and sigmoid sinus.Cerebral edema was observed in 4 pigs by MRI at the first day of follow-up,and cerebral infarction in 2 cases at the third day of follow-up,among which hemorrhagic infarction in 1 case.Cerebral edema was significantly released after 7 days of follow-up in 5 cases,and edge of cerebral infarction area became clear in 2 cases. Conclusion The method of inducing porcine cerebral venous sinus thrombosis by injection of thrombin via percutaneous transvenous catheterization is feasibile and efficient,which is more similar to the pathogenesis and disease coures of actual conditions than the former ones.
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Objective To analyze the clinical and radiological characteristics of the cerebral venous sinus thrombosis(CVST).Methods Thirteen cases of clinically proved CVST were retrospectively analyzed,focused on the clinics,MRI,and CT findings.Results Among the 13 CVST cases,3 cases was involved in the transverse sinus,while 2 cases in the superior sagittal sinus,1 case in the sigmoid sinus,2 cases in the straight sinus.Both the transverse sinus and sigmoid sinus were involved in 4 cases and both the transverse sinus and sagittal sinus were involved in 1 case.According to the onset styles,acute onset 7 cases,subacute onset 4 cases,and chronic onset 2 cases.Plain CT scan showed venous sinus as density enhanced or as low density strip.Conventional MRI showed venous sinus signal was abnormal.The enhanced CT and MRI scan manifestated the sign of△orfilling defectin the sinus involved.Magnetic resonance venography(MRV)could directly display the involved cerebral venous sinuses becoming thinner,uncontinuously,filling defected or void as well as the compensatory circulation developing.Secondary cerebral damages occured in 13 cases,including cerebral swelling,hemorrhage and infarction.Conclusions To the patients with headache as the first symptom combined with intracranial hypertension,no matter with or without neurological symptoms,CVST should be considered.The combination of CT and MRI might be helpful to the early diagnosis.
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Objective To investigate and compare the diagnostic value of CT and MR in patients with cerebral venous thrombosis. Methods The CT and MRI findings and clinical symptoms of 18 patients with cerebral venous thrombosis confirmed by DSA were retrospectively and comparatively analyzed. Results In all 18 patients,6 cases were positively manifested in CT or enhanced CT,the detective rate was 33. 3%,in which thrombi were located at superior sagittal sinus in 4 cases,transverse sinus in 1 case,sigmoid sinus in 1 case,respectively. Meanwhile,12 cases were positively manifested in MRI or MRI combined MRV,the detective rate was 88. 9%,in which thrombi were located at superior sagittal sinus in 7 cases,transverse sinus in 3 case,sigmoid sinus in 1 case,transverse sinus combined sigmoid sinus in 3 cases,sinus rectus in 1 case,cavernous sinus in 1 case,respectively. When thrombus locating at superior sagittal sinus,transverse sinus,sigmoid sinus,the detective rates of CT were 57. 1%,33. 3%,50. 0%,but the detective rates of MR were 100%,100%,50. 0%,respectively. Conclusion Compared with CT,MRI combined MRV has higher sensitivity and specificity in diagnosis of cerebral venous thrombosis,and 2D-TOF MRV can show the space structure of cerebral venous thrombus clearly which may be helpful for guiding operation.
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The dura mater was obtained from fresh cadavers at autopsy in a series of 52 specimens from 31 males and 21 females, ranging in age from 31 to 80 years. By dissecting the superior wall of dural venous sinuses, the courses and connections of all the major venous channels were examined. The configuration of the torcular herophili was divided into 11 types and four variations. The most frequent type was ScRc (29%), in which four major venous sinuses (that is the superior sagittal sinus, rectal sinus, and two transverse sinuses) joined at the same place. When the transverse or sigmoid sinus is obstructed at the time of surgery, there is a potential risk of developing brain edema. From that aspect, the variety and complexity of the torcular herophili configuration were divided into three groups. It was thought that the “freely communicating” type (63%), in which these channels possess open and unobstructed communication, had the least likelihood of brain edema, but that the “partially communicating” type (13%) and “non-communicating” type (23%) are more dangerous. Especially, the SrRr or SIRI type with complete atresia of the transverse sinus would certainly cause a marked congestion of the venous return. Light and electron microscopic observations clearly demonstrated the presence of smooth muscle cell layers in the subendothelial connective tissues. They varied in each sinus, but in the transverse and sigmoid sinuses, cell layers were thicker than in others. In 16 instances of the 52 specimens (31%), trabeculae were disclosed in and around the torcular herophili. The significance of smooth muscle cells and trabeculae is uncertain, but it is speculated that they regulate the venous blood flow to some extent by contractions and relaxations.
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Knowledge of variations in the cerebral venous anatomy and apparent signal abnormalities seen on Magnetic resonance (MR) angiography are essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST), while interpreting the MR angiograms.To evaluate the variations of cerebral venous anatomy and signal abnormalities by using 3D phase contrast MR angiography performed in a 0.5 Tesla MRI scanner.One hundred patients who underwent MR imaging and MR angiography examinations at our institution from March 2004 to February 2005, with normal MR imaging of brain were studied retrospectively. Patients with clinical suspicion of CVST and patients who underwent color doppler evaluation for suspected deep vein thrombosis were excluded.The superior sagittal, straight sinus and the internal cerebral veins were visualized in all patients. There was hypoplasia of the right transverse sinus in 13 patients, left transverse sinus in 35 patients, right sigmoid sinus in 6 patients and left sigmoid sinus in 19 patients. Absence of transverse sinus on left side was observed in one patient and absence of sigmoid sinus in 2 patients on left side. Flow gaps were observed in non-dominant transverse sinus, sigmoid sinus as well as transverse sigmoid sinus junctions. The occipital sinus was visualized in 17 patients.MR angiography done at low field strengths is also a reliable method, for assessing cerebral venous sinuses. Awareness of the normal anatomical variations of venous sinuses and apparent MR angiographic flow gaps prevent misdiagnosis of cerebral venous sinus thrombosis.
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Objective:To study the MR findings of cerebral venous sinus thrombosis and pathophysiological changes for the early diagnosis.Methods:MR findings of 11 cases of dural sinus thrombosis diagnosed by clinic and imaging were reviewed retrospectively,including six women and five men,mean age 31 years.All cases were underwent non-enhanced MRI,enhanced MRI and MR venography.Additionaly,4 patients were performed CT and 3 were underwent DSA.Results:CVST involved superior sagittal sinus in 5 cases,transverse sinus 1,sigmoid sinus 1,straight sinus 1,superior sagittal sinus and transverse sinus and sigmoid sinus 2,transverse sinus and sigmoid sinus1.Direct signs of CVST:3 cases of acute thrombus showed isointensity or iso- to hyperintensity on T1WI and hypointensity on T2WI with a hyperintensity ring was surrounded with the thrombus, which is the thickening dura.8 cases of subacute thrombus showed hyperintensity on T1WI and T2WI.The involved sinuses were demonstrated empty delta sign or sign on enhanced MRI.MR venography displayed the loss of the normal flow signal,as nonvisulization or the filling defect sign in the involved cerebral venous sinuses.The secondary cerebral damages included cerebral swelling,infarct and hemorrhage.Conclusion:MR examination plays an important role in the early diagnosis of CVST.For the early diagnosis of acute thrombus showed hypointensity on T2WI,the sign of a hyperintensity ring around the hypointensity thrombus is very helpful,and the further enhanced MRI and MR venography can help the final diagnosis earlier.
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Objective To evaluate the clinical value of MRI in children with cerebral venous sinus thrombosis(CVST).Methods MRI findings of 15 children(11 male,4 female;age ranged from 10 days to 11 years;with mean of 3.9 years) with clinically diagnosed CVST were analyzed retrospectively.All the cases were performed with plain MRI and MRV.Only 1 patient underwent contrast enhanced MRI and contrast enhanced MRV.Results The thrombosis of transverse sinus was observed in 14 children,superior sagittal sinus in 12 cases,sigmoid sinus in 11 cases and sphenoparietal sinus involvement in 1 cases.CVST was manifested as iso-hyperintensity signal on T1WI and hyperintensity signal on T2Wl in 6 cases,iso-hyperintensity signal on T1WI and hypointensity signal on T2WI in 3 cases,isointensity both on T1WI and T2WI in 3 cases and hyperintensity signal on T1WI and isointensity on T2WI in 1 case,no obvious abnormal signal on T1WI and T2WI in 2 cases.Abnormal venous enhancement was found on contrast enhanced MRI in 1 cases.Contrast enhanced MRI showed ring like,triangle and parallel enhancement in wall of venous sinus,but venous sinus thrombosis did not enhanced with irregular filling defect or empty triangle.MRV showed the venous sinus as irregular,narrow,and discontinuous with collateral circulation formation,and many circuitous superficial cortical veins and the deep veins were seen near the involved venous sinus.Conclusion MRI combined with MRV,especially CE MRI and CE MRV are effective and noninvasive methods in the diagnosis of cerebral venous sinus thrombosis,which have important value in diagnosis,treatment and follow up for pediatric CVST.
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For 150 years, the variable clinical appearance of dural sinus thrombosis has plagued clinicians. Computed tomography (CT) has alleviated much of the difficulty in making this diagnosis. A high density lesion in the involved sinus on precontrast scans and a filling defect in the sinus on postcontrast scans were the most frequently observed CT abnormalities in 12 patients with sinus thrombosis. Other findings include the cord sign and diffuse cerebral edema. Thrombosis of the superior sagittal sinus, transverse sinus, or sigmoid sinus can occur as an isolated event or in association with other disease entities and may cause no neurologic impairment.
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Objective To observe the value of MRI and magnetic resonance venography(MRV) in diagnosis of cerebral venous sinus thrombosis(CVST).Methods MRI findings of 11 patients with clinically diagnosed CVST were analyzed retrospectively.All 11 patients underwent MR plain scan.Dynamic contrast enhanced scan was performed in 5 patients,while MRV was performed in 6 and digital subtraction angiography(DSA) in 2 patients.Results The thrombosis of superior sagittal sinus and transverse sinus was observed in 4 patients,superior sagittal sinus,transverse sinus and sigmoid sinus involvement in 1,while single sigmoid sinus involvement in 4 and single transverse sinus involvement in 2 patients.CVST manifested as isointense signal on T1WI and low signal on T2WI in 1,high signal on T1WI and T2WI in 8,and inhomogeneous low signal on T1WI and high signal on T2WI in 2 patients.Abnormal venous enhancement was found on contrast enhanced MRI in 5 patients.Contrast enhancement MRI showed ring-like,triangle and parallel enhancement in wall of venous sinus,but venous sinus thrombosis did not enhanced,but showed as irregular filling defect or empty triangle.Conclusion Conventional MRI combined with MRV are effective and noninvasive methods in the diagnosis of cerebral venous sinus thrombosis.
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