Deep Cerebral Venous Thrombosis

KEY FACTS

TERMINOLOGY

• Thrombotic occlusion of deep cerebral veins

○ Usually affects both internal cerebral veins (ICVs) ± vein

of Galen (VOG), straight sinus (SS)

○ May occur with more widespread dural sinus thrombosis

IMAGING

• NECT

○ Hyperdense ICV ± VOG, SS

○ Hypodense thalami/basal ganglia (BG), loss of gray

matter-white matter (WM) interfaces

– Variable loss of deep gray-white interfaces; thalami

seem to "disappear" into background WM

hypodensity

○ ± petechial hemorrhages

• CECT

○ Loss of ICV enhancement, presence of enlarged

collateral channels

○ "Shaggy," irregular veins (collateral channels) in deep

WM, around tentorium

• MR

○ Acute clots hypointense on T2WI, "bloom" on T2*

○ Deep (medullary) WM veins prominent, tortuous on SWI

• Protocol advice

○ If CT/CECT/CTV scans negative → MR with MRV

○ If MRV equivocal → DSA

TOP DIFFERENTIAL DIAGNOSES

• Other bithalamic/basal ganglia lesions

○ Neoplasm (e.g., bithalamic astrocytoma)

○ Nonvenous ischemia (e.g., artery of Percheron infarct)

○ Toxic/metabolic disorders (e.g., CO poisoning)

CLINICAL ISSUES

• Venous thrombosis = 1-2% of strokes; ICV thrombosis =

10% of venous "strokes"

• Can present with headaches and coma

(Left) Axial graphic depicts

thrombosis of both internal

cerebral veins (ICVs) and

straight sinus (SS) ſt with 2°

hemorrhage in choroid plexus

and thalami ﬊. Edema in the

thalami, basal ganglia, and

deep cerebral white matter

(WM) are common findings.

Linear WM medullary veins ﬈

may become engorged and

enhance. (Right) NECT in a 32-

year-old woman with severe

headache shows hyperdense

ICVs ſt. Both thalami are

edematous, symmetrically

isodense ﬇ (normally

hyperdense) compared to the

surrounding WM.

(Left) Lateral DSA, venous

phase, in the same patient

shows normal opacification of

the superior sagittal sinus ﬈,

transverse sinus ﬊, and vein

of Labbé ﬉. The ICVs, vein of

Galen, and SS are thrombosed

and do not fill with contrast.

Contrast with normal DSA

with deep venous system

filling is shown on right.

(Right) Normal DSA, lateral

view, venous phase, shows

opacification of the ICV ﬈,

vein of Galen ﬊, and SS ﬉.

Trauma, and Stroke

Brain: Pathology-Based Diagnoses: Malformations,

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