【PHILIPS case per day】One case of dural sinus thrombosis (DST).

The patient is a 63-year-old man with headache

Image representation:

Non-contrast CT scan:

1.
Due to dural sinus thrombosis (DST), obvious high intensity
can be seen in the superior sagittal sinus, sinus sink, and straight sinus in the figure.

2.
There are no signs of acute intracranial hemorrhage, extraaxial effusion, and intracranial infection

CT phlebography:

1.
Filling defects can be seen in the superior sagittal sinus, sinus sink, and straight sinus, indicating dural sinus thrombosis

2.
There are no signs of acute intracranial hemorrhage, extraaxial effusion, and intracranial infection

Diagnosis: dural sinus thrombosis (DST)

The differential diagnosis ——— high density in the sinuses

1.
Hemoconcentrated state/dehydration

2.
Have recently used contrast media

3.
Acute subdural/subarachnoid hematoma

4.
Dural-sinus thrombosis (DST)

Essentials:

Clinical symptoms:

No special symptoms: headache, nausea, central nervous system damage, epilepsy
.

Venous sinus embolism must be distinguished
from patients with intracranial hypertension.

There are many precipitating factors, including any direct invasion of the dural sinus, vascular endothelium, and factors that cause venous obstruction and hypercoagulability, especially trauma, infection, tumors, pregnancy, and oral contraceptives
.

Treatment includes anticoagulation, and in severe cases, vascular interventional therapy
may be performed.

Non-contrast CT scan:

Intrasinus high-density emboli (studies show that only 25%-33% of patients occur)

· The latest study by Buyck PJ et al.
showed that HU>62 and H:H (HU: HEMATOCRIT) > 1.
52, and the diagnostic rates of acute cerebral venous embolism were 95% and 97.
5%,
respectively.

Differential diagnosis of high-density diseases in the sinuses:

High-density blood dispersed in the sinuses:

Hemoconcentrated state

Polycythemia

Dehydration

Recent use of contrast media

Subarachnoid or subdural hemorrhage: 11 high densities can be seen extending to the margin of the sinuses

However, the signs of venous congestion or infarction are complex and difficult to elude:

Non-hemorrhagic local edema: localized sulci loss, cerebral cistern and ventricle reduction but no density and signal changes;

·1/3 of cases are accompanied by subcortical hemorrhage, and the bleeding area does not correspond to the typical distribution of arterial distribution

Typical Location:

Superior sagittal sinus infarction---- adjacent to the frontal and parietal sagittal sinuses

Transverse sinus infarction---- temporal lobe, occipital lobe

Deep vein (internal cerebral veins, Galen veins, straight sinuses) embolism---- unilateral or bilateral of the thalamus, basal ganglia, and internal capsule

CT phlebography:

Direct signs: intravenous sinus filling defect --- empty triangulation

However, intrasinus separation or dural sinus perforation can lead to false negatives for this sign

Indirect signs: sickle and curtain strengthening of the brain secondary to venous embolism

Disruption of the blood-brain barrier in the area of edema

MRI1

The blood flow disappears hollowly

Abnormal signal characteristics change with the time of thrombosis

Acute phase (0-5 days) ----- T1WI and other signals, T2WI hyperintensity

Subacute phase (6-15 days) ---- T1WI, T2WI hyperintensity

Chronic phase --- different signal characteristics
.
Normal strengthening of the sinuses due to the organization of thrombosis and the formation
of branching vessels.

· GRE sequences ---- highly
sensitive to the detection of blood clots and violated bleeding veins.

MR angiography

Filling defect

Enhanced: Compared with the 2D time leap method, MR angiography has a low
sensitivity to blood flow angiography.