An Integrated Approach on the Diagnosis of Cerebral Veins and Dural Sinuses Thrombosis (a Narrative Review)
Dragos Catalin Jianu,
Silviana Nina Jianu,
Traian Flavius Dan,
Georgiana Munteanu,
Alexandra Copil,
Claudiu Dumitru Birdac,
Andrei Gheorghe Marius Motoc,
Any Docu Axelerad,
Ligia Petrica,
Sergiu Florin Arnautu,
Raphael Sadik,
Nicoleta Iacob,
Anca Elena Gogu
Affiliations
Dragos Catalin Jianu
Department of Neurosciences-Division of Neurology, Victor Babes University of Medicine and Pharmacy, E. Murgu Sq., no.2, 300041 Timisoara, Romania
Silviana Nina Jianu
Department of Ophthalmology, Dr. Victor Popescu Military Emergency Hospital, 7 G. Lazar Ave, 300080 Timisoara, Romania
Traian Flavius Dan
Department of Neurosciences-Division of Neurology, Victor Babes University of Medicine and Pharmacy, E. Murgu Sq., no.2, 300041 Timisoara, Romania
Georgiana Munteanu
Department of Neurosciences-Division of Neurology, Victor Babes University of Medicine and Pharmacy, E. Murgu Sq., no.2, 300041 Timisoara, Romania
Alexandra Copil
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babes University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Claudiu Dumitru Birdac
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babes University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Andrei Gheorghe Marius Motoc
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babes University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Any Docu Axelerad
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babes University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Ligia Petrica
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babes University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Sergiu Florin Arnautu
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences, Victor Babes University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Raphael Sadik
Department of Geriatrics-Rehabilitation, Riviera-Chablais Hospital, 3 Prairie Av, 1800 Vevey, Switzerland
Nicoleta Iacob
Department of Multidetector Computed Tomography and Magnetic Resonance Imaging, Neuromed Diagnostic Imaging Centre, 300218 Timișoara, Romania
Anca Elena Gogu
Department of Neurosciences-Division of Neurology, Victor Babes University of Medicine and Pharmacy, E. Murgu Sq., no.2, 300041 Timisoara, Romania
(1) Objective: This review paper aims to discuss multiple aspects of cerebral venous thrombosis (CVT), including epidemiology, etiology, pathophysiology, and clinical presentation. Different neuroimaging methods for diagnosis of CVT, such as computer tomography CT/CT Venography (CTV), and Magnetic Resonance Imaging (MRI)/MR Venography (MRV) will be presented. (2) Methods: A literature analysis using PubMed and the MEDLINE sub-engine was done using the terms: cerebral venous thrombosis, thrombophilia, and imaging. Different studies concerning risk factors, clinical picture, and imaging signs of patients with CVT were examined. (3) Results: At least one risk factor can be identified in 85% of CVT cases. Searching for a thrombophilic state should be realized for patients with CVT who present a high pretest probability of severe thrombophilia. Two pathophysiological mechanisms contribute to their highly variable clinical presentation: augmentation of venular and capillary pressure, and diminution of cerebrospinal fluid absorption. The clinical spectrum of CVT is frequently non-specific and presents a high level of clinical suspicion. Four major syndromes have been described: isolated intracranial hypertension, seizures, focal neurological abnormalities, and encephalopathy. Cavernous sinus thrombosis is the single CVT that presents a characteristic clinical syndrome. Non-enhanced CT (NECT) of the Head is the most frequently performed imaging study in the emergency department. Features of CVT on NECT can be divided into direct signs (demonstration of dense venous clot within a cerebral vein or a cerebral venous sinus), and more frequently indirect signs (such as cerebral edema, or cerebral venous infarct). CVT diagnosis is confirmed with CTV, directly detecting the venous clot as a filling defect, or MRI/MRV, which also realizes a better description of parenchymal abnormalities. (4) Conclusions: CVT is a relatively rare disorder in the general population and is frequently misdiagnosed upon initial examination. The knowledge of wide clinical aspects and imaging signs will be essential in providing a timely diagnosis.