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Neuroradiologic aspects of cerebral disseminated intravascular coagulation
Insights
Neurovascular disseminated intravascular coagulation (DIC) can affect large cerebral veins and sinuses, not just small arteries. This study highlights diverse neuroradiologic changes, including venous occlusions, in neurovascular DIC cases.
Area of Science:
- Neurology
- Radiology
- Hematology
Background:
- Disseminated intravascular coagulation (DIC) is a complex hematologic disorder.
- Neurovascular DIC specifically involves the brain's blood vessels.
- Traditionally, DIC is associated with microcirculatory disturbances.
Observation:
- This study examined six patients with neurovascular DIC.
- Neuroradiologic imaging revealed diverse changes.
- Large cerebral vessel involvement, particularly venous occlusions, was a key observation.
Findings:
- Four out of six patients presented with cerebral vein or sinus occlusions.
- Affected vessels included deep/superficial veins, lobar draining veins (e.g., superficial middle cerebral vein), and large sinuses (e.g., superior sagittal sinus, jugular bulb).
- Computed tomography (CT) and radionuclide sinography were valuable diagnostic tools, detecting occlusions and unusual focal hemorrhages.
Implications:
- These findings challenge the traditional view of DIC being limited to arterial microcirculation.
- Large vessel, especially venous, involvement is a significant feature of neurovascular DIC.
- Understanding these diverse radiologic manifestations is crucial for accurate diagnosis and management of neurovascular DIC.
Abstract:
Six patients with neurovascular disseminated intravascular coagulation (DIC) illustrate the diversity of neuroradiologic changes in that condition. Emphasis is placed on the involvement of large cerebral vessels, especially as reflected by cerebral vein or sinus occlusions. The latter occurred in four of the six cases reported; deep or superficial veins, larger lobar draining veins such as the superficial middle cerebral vein, or large bore vessels such as the superior sagittal sinus or jugular bulb were involved. Radionuclide sinography or computed tomography (CT) was useful in revealing large vessel occlusions or their sequelae; in two cases CT showed focal hemorrhage in an unusual location. Although DIC has classically been envisioned as occurring within the arterial microcirculation, these cases attest to the occurrence of large vessel, especially venous, involvement in neurovascular DIC.