Medical Movie Boutique Imaging signs of cerebral vein embolism

Cerebral vein embolism is uncommon and accounts for only 0.
5% of
cerebrovascular disease worldwide.
Many factors can cause cerebral venous embolism, and although cerebral venous embolism can occur at any age, it often affects neonates and young adults
.
Cerebral venous embolism is difficult to diagnose clinically because patients present with a range of nonspecific symptoms, the most common of which are headache (89% to 91%), focal neurological symptoms (52% to 68%), and epilepsy (39% to 44%)
.
Imaging findings are therefore critical
to its diagnosis.
Magnetic resonance is the most sensitive and specific imaging technique
for diagnosing cerebral vein embolism.
Different magnetic resonance sequences, flat scan or enhancement, have different diagnostic values
.
Contrast magnetic resonance phlebography has the highest
accuracy compared to non-contrast scan sequences.

Enhanced magnetic resonance phlebography may show the dural sinus and deep venous system
.
Includes superior sagittal sinus (1), lower sagittal sinus (2), transverse sinus (3), sigmoid sinus (4), internal cerebral vein (5), Rosenthal vein (6), Galen vein (7), straight sinus (8).

In women up to 15 months of age, mastoiditis, cerebral vein embolism of the sigmoid sinuses
.
Filling defects in the left sigmoid sinus (long white arrow) and fluid accumulation behind the pinna are consistent with the abscess presentation (white*).

71-year-old man with cerebral vein embolism of cavernous sinus, horizontal monocular diplopia, oculomotor nerve and trochlear nerve palsy, right ptosis, suspected painful ophthalmoplelegic syndrome
.
(a) T2WI hyper-intensity shadow (long white arrow) in the right cavernous sinus and T1WI low-signal shadow (white long arrow) in the corresponding region (b) are consistent with cerebral vein embolism
.
(C figure) Enhanced magnetic resonance visible filling defect.

27-year-old man with cerebral vein embolism in superior sagittal sinus and right transverse sinus, headache, history of cocaine abuse
.
(A, B), axial non-contrast CT, showing abnormally high-density opacities of the right transverse sinus and superior sagittal sinus, consistent with cerebral vein embolism (long white arrow).

(c figure) Axial CT with δ sign (long white arrow)
visible.

Subacute cerebral venous embolism, 27-year-old woman, severe headache for 7 days
.
(Panel A, Panel B) right transverse sinus signal elevation area (long white arrow), (Panel C) right transverse sinus and right sigmoid sinus lack blood flow signal (white long arrow).

Chronic cerebral vein embolism of left transverse and sigmoid sinuses, 62-year-old female, epilepsy
.
(Figure a) Low-signal emboli such as T1WI (white long arrow), (b) T2WI high-signal emboli (white long arrow), (Figure c) lack blood flow signals
in the left transverse sinus and sigmoid sinus due to cerebral venous embolism.

68-year-old man with several years history of cerebral vein embolism and incomplete recanalization
.
(Figure A) Axial enhanced magnetic resonance phlebography showing residual filling defects (long white arrows)
in the right transverse sinus.
(b) Sagittal T2WI shows an irregular appearance of the upper sagittal sinus (long white arrows).

(C-figure) Axial enhanced magnetic resonance phlebography showing severe diffuse cerebral vein filling
.
(D-figure) Lateral digital subtraction angiography shows dural arteriovenous fistula (long white arrow), noting early drainage
of the left transverse and sigmoid sinuses after left carotid artery input.

A series of axial magnetic resonance images superimposed in color showing the area of
venous drainage.
Drainage area of cortical veins and superior sagittal sinus (red), middle cerebral vein and cavernous sinus drainage area (green), transverse sinus and Labbe vein drainage area (yellow), deep cerebral vein drainage area (purple).

Bleeding or edema in these areas may represent cerebral venous embolism of the corresponding dural sinus or vein
.

Vasogenic edema, 62-year-old woman, epilepsy with stage IV gastric cancer
.
(a) Axial FLAIR image showing temporal lobe subcortical edema (white long arrow), (b) ADC image showing increased ADC value (white long arrow), (c) axial enhanced magnetic resonance phlebography, showing left transverse sinus filling defect (white long arrow), (d figure) re-examination after 4 months, axial FLAIR image, showing vasogenic edema basically dissipated (white long arrow).

Empty δ sign, 85-year-old man, epilepsy with colon cancer
.
CT with axial contrast shows right-sided frontal hemorrhage (white*) and cerebral venous embolism in the superior sagittal sinus, positive for empty δ (long white arrows).

Parenchymal hemorrhage, 37-year-old woman, headache for 10 days, history of
oral contraceptives.
(A) Axial non-contrast CT image, showing left temporoparietal subcortical hematoma
.
(Figure B) Magnetic resonance venous imaging shows that due to cerebral vein embolism, the blood flow signal in the left transverse sinus, left sigmoid sinus, and left internal jugular vein disappears (long white arrow).

Cortical edema, 41-year-old woman with headache and epilepsy
.
(a) Axial FLAIR showed edema of the right occipital lobe and temporal cortex (long white arrow), and (b) coronal enhanced magnetic resonance venous imaging showed the loss of blood flow signals in the right transverse sinus and sigmoid sinus, consistent with cerebral venous embolism (white long arrow).

Normal appearance
of arachnoid granules.
(Figure A) Axial enhanced magnetic resonance venous imaging, showing a circular filling defect (long white arrow)
with a clear inner boundary of the right transverse sinus.
(b) The axial T2WI shows that the signal of the arachnoid granules is similar to that of cerebrospinal fluid (long white arrows).

High bifurcation
of the superior sagittal sinus.
(A) Continuous axis-enhanced CT images showing false air δ signs (long black arrows).

(B) Frontal digital subtraction angiography showing the high bifurcation (long white arrow)
of the superior sagittal sinus.

Transverse sinus blood flow gap
.
(Figure A) Coronal time leap magnetic resonance venous imaging, showing significant interruption of blood flow signals in the right transverse sinus (long white arrow).

(B-figure) Axial enhanced magnetic resonance venous imaging showing normal blood flow signals (long white arrows)
of the right transverse sinus.

Empty signal disappeared, 27-year-old woman, headache
.
(a) Axial FLAIR shows the disappearance of the left transverse sinus flow signal (black long arrow), (b figure) Axial T2WI shows the disappearance of the left transverse sinus flow air signal (white long arrow), (c figure) coronal three-dimensional phase contrast magnetic resonance venous imaging, showing the left transverse sinus blood flow signal disappearing (white long arrow).

Although artifacts were suspected in both Figures A and C, enhanced magnetic resonance studies
were performed in view of the headache in a young woman.
(dFig) Axial enhancement T1WI shows normal blood flow signals in the left transverse sinus (long white arrow).

Deep vein thrombosis of the brain, 50-year-old female, mental
retardation.
(A) Axial non-contrast CT showed bilateral thalamic density reduction (long white arrows), indicating edema
.
(b) Axial non-contrast CT shows high-density opacities (long white arrows) of internal cerebral veins, suggesting cerebral vein embolism
.
(c) Axial FLAIR image showing bilateral thalamic edema (long white arrows).

(d) The axial T2* sequence shows left thalamic hemorrhagic lesions (long white arrows).

Deep vein embolism of the brain, 21-year-old woman, headache, history of
oral contraceptives.
(a) The axial DWI shows the designaling of the thalamus and basal ganglia (white long arrow), and the ADC plot shows a decrease in ADC value (white long arrow), which is consistent with cytotoxic edema changes
.
(c) Sagittal T1WI shows abnormally high intensity shadows (long white arrows) in the internal cerebral veins, suggesting cerebral vein embolism
.
(d-figure) Axial SWI shows abnormally low signal (long white arrow) in the intracerebral vein region, note hemorrhagic lesions
of the left thalamus.

Hyperemia of the deep medullary vein or cerebral vein embolism, 12 days after birth in a baby
boy.
(a) Axial T2WI linear low-intensity white matter lesions (long black arrows) matched
(b) axial T1WI linear high-intensity lesions (white long arrows).

Solitary cortical venous embolism, 11-year-old male, acute lymphoblastic leukemia
.
(A) Axial non-contrast CT showed high-density opacities in the cortical veins, and the cord sign was positive (long white arrow).

(b) The axial T1WI shows intravenous hyperintensity shadows (long white arrows).

(c) SWI shows a low signal of the cortical veins (long white arrows).

(d-figure) Axial FLAIR shows subcortical edema (long white arrow).

Solitary cortical venous embolism, 98-year-old woman with mild paralysis of the right upper extremity
.
(a) Axial non-contrast CT shows subcortical focal hemorrhage (long white arrow), and when this finding is present, the density of the cortical veins should be
measured.
(b) Axial non-contrast CT showed high-density opacities of cortical veins, and the cord sign was positive (long white arrow), suggesting cerebral vein embolism
.