The Role of Imaging in the Diagnosis of Cerebral Vein Thrombosis

Cerebral venous thrombosis is a rare but serious neurologic disorder manifested clinically with headache, focal neurological deficits, seizures, impairment of consciousness and papilledema. Causes and predisposing factors include local conditions such as brain injury, intracranial and regional infection as well as systemic conditions such as changes in hormonal states (e.g. recent abortion, pregnancy, oral contraceptives), recent surgical procedures, hypercoagulable states, connective tissue disease, malignancy, systemic infection and dehydration. The diagnosis is typically based on clinical suspicion and imaging confirmation, but can be difficult due to the diversity of underlying risk factors. Non-contrast computer tomography remains the first imaging modality in most emergency situations, but magnetic resonance imaging and magnetic resonance venography have been considered as the techniques of choice with high suspicion patients. Alternatively, computer tomography venography is a cheaper, faster and readily available technique and has been shown to be comparable to magnetic resonance venography. Anatomic variants of cerebral venous structures are common and can be difficult to distinguish from pathology. Invasive diagnostic techniques such as digital subtraction angiography are mostly reserved for situations when endovascular treatment is being considered.