Vol. 3, Issue 1, Article 3

Mironov

Purpose

Intracranial venous occlusive disease, for the greater part, is equated with occlusion of the dural sinuses. Generally we know very little about the occlusion of deep and cortical veins in the absence of sinus occlusion. The imaging characteristic of non-inflammatory thrombosis, limited to cortical or small draining veins and its sequel, is not familiar in practice.

We tried to identify the imaging characteristic and its clinical relation in patients with acute stroke as consequence of isolated affections of cortical or small veins in 60 consecutive cases.

Materials & Methods

From 700 patients undergoing stroke selection 60 cases were considered as non-arterial diseases and prospectively studied: They had experienced sensomotor symptoms of different severity.

Each case underwent CT, MRI and catheter angiography studies.

The angiographic studies were performed with preferences especially for detailed analyses of the venous angiomorphology, including proper oblique views.

Results

Patterns of brain lesions on CT or MR imaging were categorized as hemorrhagic and/or ischemic.

1. Hemorrhagic lesions:
   42 patients (mean age 52 +/- 22) had brain hemorrhages:
   • in 22 cases one-time lesions were identified;
   • 20 patients had some evidence of sequential repeated bleedings.

2. Non-hemorrhagic lesions:
   In 18 patients (mean age 45 +/- 25) only ischemic lesions were detected:
   • 16 cases demonstrated venous occlusions;
   • in 2 cases with venous developmental anomaly an acute decompensation of the drainage veins has been observed;

3. CT & MR imaging:
   The observed hemorrhagic lesions were polymorphic, separated into segments and often with different age of occurrence. An extension into subdural space had been detected in 12 cases.

   The morphological locations of imaging features were not related to any arterial territories.

4. Angiographic imaging:
   The catheter angiography detected pathological changes of the cortical veins as isolated thrombosis, venous stasis, venous collateral features, or delay in the local circulation in all cases.

5. Treatment:
   In 6 cases with hemorrhages and in 15 cases with ischemic features an anticoagulant treatment was successfully implicated.

Conclusion

The result of the study indicated that an isolated thrombosis of cerebral veins perhaps is more often than commonly recognized. An affection of cortical and small veins should be expected in cases with isolated thrombosis, regional venous stasis, venous collateral features, or delay in the local venous circulation. The affirmative clinical results obtained with anticoagulant therapy in such cases justify the effort to identify an isolated venous thrombosis.

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