Lisette van Dam

Magnetic resonance thrombus imaging in cerebral vein thrombosis 8 137 BACKGROUND Cerebral vein thrombosis (CVT) includes thrombosis of the dural sinuses and cerebral veins and is an uncommon presentation of venous thrombosis. 1 The imaging test of choice for diagnosing CVT is computed tomography (CT) ormagnetic resonance imaging (MRI) venography. 2 Even though CT and MRI venography have a high sensitivity and specificity for CVT 3 , the diagnosis can be challenging due to complex anatomic variation of cerebral veins and sinuses 2 and also in patients in whom venous sinuses are affected by brain tumours or after intracranial surgery. Magnetic resonance non-contrast thrombus imaging (MR-NCTI) has been shown to be sensitive and specific for the diagnosis of CVT 4,5 as well as difficult- to-diagnose venous thrombosis in other locations, including suspected recurrent ipsilateral deep vein thrombosis (DVT) of the leg or isolated pelvic vein thrombosis in pregnant patients. 6-10 In our view, MR-NCTI therefore has potential added value in the diagnostic management of suspected CVT. CASE PRESENTATION We present a 52-year-old patient in whom acute CVT could not be excluded on CT and MRI venography due to post-surgical changes of venous sinuses and in whom the final treatment decision was based on MR-NCTI. She presented at the emergency department with a mild, pressing headache with concomitant nausea that had started three weeks before presentation. In the week before presentation, she had experienced three episodes of acute and intense worsening of the headache, all of which occurred during exercise. Except for blurry vison, she reported no other symptoms. Her medical history included a craniotomy for right sided parieto-occipital meningioma five years ago. She smoked 30 cigarettes per day and was treated with simvastatin because of hypercholesteremia. She did not use oral contraceptives. On physical examination, her blood pressure was 149/87 mmHg, and the heartrate was 84 bpm. The Glasgow Coma Scale was 15/15. Further neurologic examination revealed no abnormalities, in particular no papilledema. Non-contrast brain CT showed a tissue defect in the right parieto-occipital region, compatible with the postoperative status. CT venography showed no opacification of the posterior part of the superior sagittal sinus and both transverse sinuses