Diffusion-weighted Image and the Prediction of Brain Venous Thrombosis Development on Magnetic Resonance – Two Case Reports


Authors: A. Burgetová 1;  Z. Seidl 1,2;  J. Lisý 3;  P. Dušek 4;  M. Mašek 1;  M. Vaněčková 1
Authors‘ workplace: Radiodiagnostická klinika 1. LF UK a VFN v Praze 1;  Vyšší zdravotnická škola, Praha 2;  Klinika zobrazovacích metod 2. LF UK a FN v Motole, Praha 3;  Neurologická klinika 1. LF UK a VFN v Praze 4
Published in: Cesk Slov Neurol N 2011; 74/107(3): 339-343
Category: Case Report

Overview

We present two cases with diagnoses of cerebral venous thrombosis with extensive pathological changes supporting ischemia on conventional MR imaging (MRI). MR angiography disclosed thrombosis of the vein of Galen and cerebral sinuses. The findings were different on diffusion-weighted imaging (DWI) and on ADC maps. The first case exhibited high signal intensity on DWI and intermediate-to-low signal intensity on ADC (apparent diffusion coefficient) maps in the affected area. This indicated cytotoxic oedema and ischemic lesions. The second case showed intermediate-to-low signal intensity on DWI and high signal intensity on ADC maps. This indicated vasogenic oedema. The severe clinical status of both patients necessitated admittance to the intensive care unit and anticoagulation therapy. In the first case, six months after symptoms onset, signs of organic psychosyndrome, cephalea and vertigo remained. MRI indicated that a residue of the haemorrhage ischemic lesion in the left thalamus persisted, with high signal on T2WI and low signal with mild hypersignal margin on T1WI. In the second case, MR findings and normalization of clinical status after anticoagulation therapy indicated complete remission. We suggest that DWI and ADC contribute to diagnosis and enable a certain degree of prediction of clinical course.

Key words:
cerebral venous thrombosis – magnetic resonance imaging – diffusion weighted imaging – posterior reversible encephalopathy syndrome


Sources

1. Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005; 352(17): 1791–1798.

2. Yuh WT, Simonson TM, Wang AM, Koci TM, Tali ET, Fisher DJ et al. Venous sinus occlusive disease: MR findings. AJNR Am J Neuroradiol 1994; 15(2): 309–316.

3. Schaefer PW, Buonanno FS, Gonzales RG, Schwamm RH. Diffusion,weighted imaging discriminates between cytotoxic and vasogenic oedema in patient in eclampsia. Stroke 1997; 28(5): 1082–1085.

4. Warach S, Gaa J, Siewert B, Wielopolski P, Edelman RR. Acute human stroke studies by whole brain echo planar diffusion, weighted magnetic resonance imaging. Ann Neurol 1995; 37(2): 231–241.

5. Kinoshita T, Moritani T, Shrier DA, Hiwatashi A, Wang HZ, Numaguchi Y. Diffusion-weighted MR imaging of posterion reversible leukoencephalpathy syndrome. A pictorial essay. J Clinical Imaging 2003; 27(5): 307–315.

6. Lövblad KO, Bassetti C, Schneider J, Ozdoba C, Remonda L, Schroth G. Diffusion-weighted MRI suggests of the coexistence of cytotoxic and vasogenic oedema in e case of deep cerebral venous thrombosis. Neuroradiol 2000; 42(10): 728–731.

7. Lövblad KO, Bassetti C, Schneider J, Guzman R, El-Koussy M, Remonda L et al. Diffusion-weighted MR in cerebral venous thrombosis. Cerebrovas Dis 2001; 11(3): 169–176.

8. Röther J, Waggie K, van Bruggen N, de Crespigny A, Moseley ME. Experimental cerebral venous thrombosis: evalution using magnetic resonance imaging. J Cerebral Blood Flow Metab 1996; 16(6): 1353–1361.

9. Keller E, Flacke S, Urbach H, Schild HH. Diffusion- and perfusion-weighted magnetic resonance imaging in deep cerebral venous thrombosis. Stroke 1999; 30(5): 1144–1146.

10. Fugate JE, Claassen DO, Cloft HJ, Kallmes DF Kozak OS, Rabinstein AA. Posterior reversible encephalopathy syndrome: associated clinical and radiologic findings. Mayo Clin Proc 2010; 58(5): 427–432.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2011 Issue 3

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account