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A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
Published on: June 2, 2015
A clinico-radiological study of deep cerebral venous thrombosis
Jayantee Kalita1, Abhishek Sachan2, Ashish K Dubey2
1Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli, Lucknow, Uttar Pradesh, 226014, India. jayanteek@yahoo.com.
Insights
Isolated deep cerebral venous thrombosis (DCVT) is rare. While additional sinus thrombosis presents more severe illness and higher mortality, long-term outcomes for survivors are similar in both isolated DCVT and combined cases.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Deep cerebral venous thrombosis (DCVT) can occur in isolation or with concurrent sinus thrombosis.
- Understanding the distinct clinical and radiological profiles of isolated DCVT versus DCVT with sinus involvement is crucial for patient management.
Purpose of the Study:
- To compare the clinical and radiological findings and outcomes of patients with isolated DCVT against those with DCVT and additional sinus thrombosis.
Main Methods:
- A cohort of 41 patients diagnosed with DCVT via MR venography was divided into two groups: isolated DCVT (Group A) and DCVT with additional sinus thrombosis (Group B).
- Clinical features, risk factors, MRI findings, and outcomes at 1, 3, and 6 months were analyzed and compared between the groups.
Main Results:
- Group B patients (with sinus thrombosis) exhibited a shorter illness duration, more frequent vomiting, and higher rates of papilledema.
- While Group A (isolated DCVT) showed more frequent thalamic and basal ganglia lesions on MRI, Group B had higher mortality at 1 month.
- Good outcomes were observed in 50% of Group A and 60.6% of Group B at 1 month, improving to 62.5% and 80.6% respectively by 3 months, with negligible further improvement.
Conclusions:
- Isolated DCVT is an uncommon presentation.
- The presence of additional sinus thrombosis in DCVT cases is associated with more severe clinical presentation and increased mortality.
- Despite initial differences in severity and short-term outcomes, long-term prognoses for survivors are comparable between isolated DCVT and DCVT with sinus thrombosis.
Purpose:
Isolated deep cerebral venous thrombosis (DCVT) may have different presentation and outcome compared to DCVT with additional sinus thrombosis. We compare clinico-radiological findings and outcomes of patients with isolated DCVT with those having additional sinus thrombosis.
Methods:
Forty-one DCVT patients with or without additional sinus thrombosis were included. Deep CVT was diagnosed if there was thrombosis of straight sinus, vein of Galen, internal cerebral vein, or basal vein of Rosenthal on MR venography (MRV). Isolated DCVT patients were classified as Group A and those with additional sinus thrombosis as Group B. The clinical features, risk factors, MRI findings, and outcomes at 1, 3, and 6 months were compared between Groups A and B.
Results:
Median age was 28 years, and 22 (54%) were females. Eight (19.5%) patients were in Group A and 33 (80.5%) in Group B. Group B patients had shorter duration of illness (7 vs 30 days; p = 0.01), frequent vomiting [25 (75.7%) vs 2 (25%); p = 0.01], and papilledema [13 (39%) vs 0 (0%); p = 0.04]. Risk factors were comparable. MRI revealed bilateral thalamic [5 (62.5%) vs 6 (18.2%)] and basal ganglia [(4 (50%) vs 6 (18.2%)] lesions more frequently in Group A. At 1 month, 2 (6%) patients died in Group B and none in Group A, and 24 had good outcome (50% Group A and 60.6% in Group B). At 3 months, 30 had good outcome (62.5% Group A and 80.6% in Group B). Improvement after 3 months was negligible.
Conclusion:
Isolated DCVT is rare, and additional sinus thrombosis is associated with more severe illness and death. However, long-term outcomes in the survivors are similar between the two groups.
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