Preliminary Diagnosis: Intracranial Venous Thrombosis

I. What imaging technique is first-line for this diagnosis

  • CT venogram with contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of intracranial venous thrombosis.

Advantages
  • Relatively inexpensive, fast imaging modality

  • Excellent for assessment of any associated osseous abnormalities

Disadvantages
  • Exposes the patient to ionizing radiation

  • Cannot be used to treat dural venous sinus thrombosis

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • MR of the brain with contrast

  • Catheter angiography of the dural venous sinuses.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of intracranial venous thrombosis.

MR of the brain with contrast
Advantages
  • Does not expose the patient to ionizing radiation

  • Able to detail any particular soft tissue mass, fluid collection, or vascular malformation that may be causing dural venous sinus thrombosis with great sensitivity and specificity

  • Better able to differentiate arachnoid granulation from true dural venous sinus thrombosis than CT

Disadvantages
  • Expensive

  • Time-consuming

  • Requires significant patient cooperation to minimize motion artifact

Catheter angiography of the dural venous sinuses
Advantages
  • Not only able to diagnose but also treat dural venous sinus thrombosis

Disadvantages
  • More invasive procedure with greater and more severe complications

  • More expensive and exposes the patient to large amounts of ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

MR of the brain with contrast
  • Contraindicated in patients with non-MR compatible hardware

Catheter angiography of the dural venous sinuses
  • May be contraindicated in patients in a severe hypercoagulable state

  • Relative contraindication in patients with renal failure