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  • Print publication year: 2012
  • Online publication date: August 2012

Chapter 48 - Cerebral venous thrombosis

from Section 2 - Vascular topographic syndromes


Since the first description of Wallenberg's syndrome more than 100 years ago, clinical and pathological findings of lateral medullary infarction (LMI) have been sporadically reported. Dizziness and ataxia are one of the most common symptoms/signs of lateral medullary infarction (LMI). Other symptoms/signs include nystagmus and ocular motor abnormality, dysphagia, dysarthria, hoarseness, nausea/vomiting, and hiccup. In patients with normal angiographic findings, atherothrombotic occlusion of a perforating artery itself seems to be the mechanism of infarction. Medial medullary infarction is usually caused by occlusion of penetrating branches associated with an atherosclerotic distal vertebral artery (VA) or vertebral arteries-basilar artery (VA-BA) junction. Lateral and medial medullary infarction may occur simultaneously or consecutively. Spontaneous primary medullary hemorrhage is rare. Although the causative role of hypertension is controversial, autopsy and imaging studies illustrate that hypertensive medullary hemorrhage does exist. Cavernous angiomas are a relatively frequent cause of medullary hemorrhage.
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1. FerroJM, CanhaoP, StamJ, et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35: 664–670.
2. BousserMG, FerroJM.Cerebral venous thrombosis: an update. Lancet Neurol 2007; 6: 162–170.
3. StamJ.Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005; 352: 1791–1798.
4. deVeberG, AndrewM, AdamsC, et al. Cerebral sinovenous thrombosis in children. N Engl J Med 2001; 345: 417–423.
5. GarcinR, PestelM.Thrombophlébites cérébrales. Paris: Masson, 1949.
6. KalbagRM, WoolfAL.Cerebral Venous Thrombosis. Vol 1. London: Oxford University Press, 1967.
7. BousserMG, Ross RusselR.Cerebral Venous Thrombosis. London: Saunders, 1997.
8. AmeriA, BousserMG.Cerebral venous thrombosis. Neurol Clin 1992; 10: 87–111.
9. CumurciucR, CrassardI, SarovM, et al. Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases. J Neurol Neurosurg Psychiatry 2005; 76: 1084–1087.
10. LafitteF, BoukobzaM, GuichardJP, et al. MRI and MRA for diagnosis and follow-up of cerebral venous thrombosis (CVT). Clin Radiol 1997; 52: 672–679.
11. BoukobzaM, CrassardI, BousserMG.When the “dense triangle” in dural sinus thrombosis is round. Neurology 2007; 69: 808.
12. LinnJ, PfefferkornT, IvanicovaK, et al. Noncontrast CT in deep cerebral venous thrombosis and sinus thrombosis: comparison of its diagnostic value for both entities. AJNR Am J Neuroradiol 2009; 30: 728–735.
13. VirapongseC, CazenaveC, QuislingR, et al. The empty delta sign: frequency and significance in 76 cases of dural sinus thrombosis. Radiology 1987; 162: 779–785.
14. IdbaihA, BoukobzaM, CrassardI, et al. MRI of clot in cerebral venous thrombosis: high diagnostic value of susceptibility-weighted images. Stroke 2006; 37: 991–995.
15. SelimM, FinkJ, LinfanteI, et al. Diagnosis of cerebral venous thrombosis with echo-planar T2*-weighted magnetic resonance imaging. Arch Neurol 2002; 59: 1021–1026.
16. BoukobzaM, CrassardI, BousserMG, et al. MR imaging features of isolated cortical vein thrombosis: diagnosis and follow-up. AJNR Am J Neuroradiol 2009; 30: 344–348.
17. UrbanPP, Muller-ForellW.Clinical and neuroradiological spectrum of isolated cortical vein thrombosis. J Neurol 2005; 252: 1476–1481.
18. KawaboriM, KurodaS, KudoK, et al. Susceptibility-weighted magnetic resonance imaging detects impaired cerebral hemodynamics in the superior sagittal sinus thrombosis – case report. Neurol Med Chir (Tokyo) 2009; 49: 248–251.
19. ThomasB, SomasundaramS, ThamburajK, et al. Clinical applications of susceptibility weighted MR imaging of the brain – a pictorial review. Neuroradiology 2008; 50: 105–116.
20. TongKA, AshwalS, ObenausA, et al. Susceptibility-weighted MR imaging: a review of clinical applications in children. AJNR Am J Neuroradiol 2008; 29: 9–17.
21. ChuK, KangDW, YoonBW, et al. Diffusion-weighted magnetic resonance in cerebral venous thrombosis. Arch Neurol 2001; 58: 1569–1576.
22. FavroleP, GuichardJP, CrassardI, et al. Diffusion-weighted imaging of intravascular clots in cerebral venous thrombosis. Stroke 2004; 35: 99–103.
23. LovbladKO, BassettiC, SchneiderJ, et al. Diffusion-weighted mr in cerebral venous thrombosis. Cerebrovasc Dis 2001; 11: 169–176.
24. LeachJL, FortunaRB, JonesBV, et al. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics 2006; 26: S19–S41; discussion S2–S3.
25. AyanzenRH, BirdCR, KellerPJ, et al. Cerebral MR venography: normal anatomy and potential diagnostic pitfalls. AJNR Am J Neuroradiol 2000; 21: 74–78.
26. FarbRI, ScottJN, WillinskyRA, et al. Intracranial venous system: gadolinium-enhanced three-dimensional MR venography with auto-triggered elliptic centric-ordered sequence – initial experience. Radiology 2003; 226: 203–209.
27. LiangL, KorogiY, SugaharaT, et al. Evaluation of the intracranial dural sinuses with a 3D contrast-enhanced MP-RAGE sequence: prospective comparison with 2D-TOF MR venography and digital subtraction angiography. AJNR Am J Neuroradiol 2001; 22: 481–492.
28. MeckelS, ReisingerC, BremerichJ, et al. Cerebral venous thrombosis: diagnostic accuracy of combined, dynamic and static, contrast-enhanced 4D MR venography. AJNR Am J Neuroradiol 2010; 31: 527–535.
29. RollinsN, IsonC, ReyesT, et al. Cerebral MR venography in children: comparison of 2D time-of-flight and gadolinium-enhanced 3D gradient-echo techniques. Radiology 2005; 235: 1011–1017.
30. DormontD, SagK, BiondiA, et al. Gadolinium-enhanced MR of chronic dural sinus thrombosis. AJNR Am J Neuroradiol 1995; 16: 1347–1352.
31. LinnJ, Ertl-WagnerB, SeelosKC, et al. Diagnostic value of multidetector-row CT angiography in the evaluation of thrombosis of the cerebral venous sinuses. AJNR Am J Neuroradiol 2007; 28: 946–952.
32. OzsvathRR, CaseySO, LustrinES, et al. Cerebral venography: comparison of CT and MR projection venography. AJR Am J Roentgenol 1997; 169: 1699–1707.
33. PoonCS, ChangJK, SwarnkarA, et al. Radiologic diagnosis of cerebral venous thrombosis: pictorial review. AJR Am J Roentgenol 2007; 189: S64–S75.
34. FinkJN, McAuleyDL.Mastoid air sinus abnormalities associated with lateral venous sinus thrombosis: cause or consequence?Stroke 2002; 33: 290–292.
35. DucreuxD, OppenheimC, VandammeX, et al. Diffusion-weighted imaging patterns of brain damage associated with cerebral venous thrombosis. AJNR Am J Neuroradiol 2001; 22: 261–268.
36. YoshikawaT, AbeO, TsuchiyaK, et al. Diffusion-weighted magnetic resonance imaging of dural sinus thrombosis. Neuroradiology 2002; 44: 481–488.
37. ForbesKP, PipeJG, HeisermanJE.Evidence for cytotoxic edema in the pathogenesis of cerebral venous infarction. AJNR Am J Neuroradiol 2001; 22: 450–455.
38. MullinsME, GrantPE, WangB, et al. Parenchymal abnormalities associated with cerebral venous sinus thrombosis: assessment with diffusion-weighted MR imaging. AJNR Am J Neuroradiol 2004; 25: 1666–1675.
39. HaapaniemiE, TatlisumakT.Is D-dimer helpful in evaluating stroke patients? A systematic review. Acta Neurol Scand 2009; 119: 141–150.
40. CrassardI, SoriaC, TzourioC, et al. A negative D-dimer assay does not rule out cerebral venous thrombosis: a series of seventy-three patients. Stroke 2005; 36: 1716–1719.
41. CosmiB, LegnaniC, TosettoA, et al. Comorbidities, alone and in combination with D-dimer, as risk factors for recurrence after a first episode of unprovoked venous thromboembolism in the extended follow-up of the PROLONG study. Thromb Haemost 2010; 103: 1152–1160.
42. EinhauplK, StamJ, BousserMG, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol 2010; 17: 1229–1235.
43. CanhaoP, FerroJM, LindgrenAG, et al. Causes and predictors of death in cerebral venous thrombosis. Stroke 2005; 36: 1720–1725.
44. CanhaoP, CortesaoA, CabralM, et al. Are steroids useful to treat cerebral venous thrombosis?Stroke 2008; 39: 105–110.
45. CoutinhoJM, FerroJM, CanhaoP, et al. Cerebral venous and sinus thrombosis in women. Stroke 2009; 40: 2356–2361.
46. PetzoldA, SmithM.High intracranial pressure, brain herniation and death in cerebral venous thrombosis. Stroke 2006; 37: 331–332.
47. StefiniR, LatronicoN, CornaliC, et al. Emergent decompressive craniectomy in patients with fixed dilated pupils due to cerebral venous and dural sinus thrombosis: report of three cases. Neurosurgery 1999; 45: 626–9; discussion 9–30.
48. TheaudinM, CrassardI, BressonD, et al. Should decompressive surgery be performed in malignant cerebral venous thrombosis?: a series of 12 patients. Stroke 2010; 41: 727–731.
49. EinhauplKM, VillringerA, MeisterW, et al. Heparin treatment in sinus venous thrombosis. Lancet 1991; 338: 597–600.
50. de BruijnSF, StamJ.Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke 1999; 30: 484–488.
51. CoutinhoJM, FerroJM, CanhaoP, et al. Unfractionated or low-molecular weight heparin for the treatment of cerebral venous thrombosis. Stroke 2010; 41: 2575–2580.
52. CanhaoP, FalcaoF, FerroJM.Thrombolytics for cerebral sinus thrombosis: a systematic review. Cerebrovasc Dis 2003; 15: 159–166.
53. CicconeA, CanhaoP, FalcaoF, et al. Thrombolysis for cerebral vein and dural sinus thrombosis. Cochrane Database Syst Rev 2004; CD003693.
54. StamJ, MajoieCB, van DeldenOM, et al. Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. Stroke 2008; 39: 1487–1490.
55. KoopmanK, UyttenboogaartM, VroomenPC, et al. Long-term sequelae after cerebral venous thrombosis in functionally independent patients. J Stroke Cerebrovasc Dis 2009; 18: 198–202.
56. PutaalaJ, HiltunenS, SalonenO, et al. Recanalization and its correlation to outcome after cerebral venous thrombosis. J Neurol Sci 2010; 292: 11–15.
57. MartinelliI, BucciarelliP, PassamontiSM, et al. Long-term evaluation of the risk of recurrence after cerebral sinus-venous thrombosis. Circulation 2010; 121: 2740–2746.
58. DentaliF, GianniM, CrowtherMA, et al. Natural history of cerebral vein thrombosis: a systematic review. Blood 2006; 108: 1129–1134.