MR staging of acute dural sinus thrombosis: correlation with venous pressure measurements and implications for treatment and prognosis

• Published in: American journal of neuroradiology : AJNR Vol. 16; no. 5; pp. 1021 - 1029
• Main Authors: Tsai, FY, Wang, AM, Matovich, VB, Lavin, M, Berberian, B, Simonson, TM, Yuh, WT
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.05.1995; American Society of Neuroradiology
• Subjects: Acute Disease; Adolescent; Adult; Aged; Biological and medical sciences; Brain - pathology; Brain Edema - diagnosis; Brain Edema - physiopathology; Cerebral Angiography; Female; Humans; Infant; Infant, Newborn; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Angiography; Male; Medical sciences; Middle Aged; Nervous system; Prognosis; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Sinus Thrombosis, Intracranial - diagnosis; Sinus Thrombosis, Intracranial - drug therapy; Sinus Thrombosis, Intracranial - physiopathology; Thrombolytic Therapy; Venous Pressure - physiology; Performance evaluation; Human; Intracranial; Nervous system diseases; Correlation; Prognosis; Cardiovascular disease; Exploration; Nuclear magnetic resonance imaging; Thrombosis; Cerebral disorder; Vascular disease; Treatment; Central nervous system disease; Technique; Cerebrovascular disease; Venous pressure; Dural sinus
• ISSN: 0195-6108; 1936-959X

To correlate parenchymal brain changes, venous sinus pressure measurements, and outcome in 29 patients with acute dural sinus thrombosis. A retrospective review of 29 patients with angiographically proved acute dural sinus thrombosis was made from January 1989 to December 1993. MR examinations were performed on either a 0.5- or 1.5-T superconductive scanner in multiple planes. Direct dural sinus venography, cerebral angiography, and MR venography were performed. Venous sinus pressure measurements were obtained in 11 of 29 patients. We identified five distinct stages of brain parenchymal changes; each stage correlated with increasing intradural sinus pressure. The pressures measured in this study ranged from 20 to 50 mm Hg. Brain parenchymal changes were reversible up to stage III if thrombolytic treatment was performed. Beyond stage III, there were some residual changes, even after thrombolysis. All stage V patients died. Acute dural sinus thrombosis leads to distinct stages of parenchymal changes, the severity of which depends on the degree of venous congestion, which, in turn, is closely related to intradural sinus pressure. As intradural sinus pressure increases, progression from mild parenchymal change to severe cerebral edema and/or hematoma may occur if thrombolysis is delayed.