Cerebral sinovenous thrombosis can cause elevation in venous pressure, increased intracranial pressure, and venous infarction. Hemorrhagic infarction (40%) and hydrocephalus (10%) may complicate cerebral sinovenous thrombosis [77]. Infarctions are more frequently hemorrhagic in neonates (72%) than in older children (48%) [79]. The lateral dural venous sinuses (73%) and superior sagittal sinus (35%) are most commonly affected [76- 78]. CT Head CT Head Unenhanced CT shows increased density, often accompanied by distension, of the thrombosed sinus or vein [77,80]. CT is less sensitive than MRI for the demonstration of early ischemic infarction but readily shows areas of brain hemorrhage [77,79]. MRV Head MRV is used to diagnose and follow cortical vein and dural venous sinus thrombosis and is typically performed in conjunction with anatomic MRI without and with IV contrast for a comprehensive assessment of the intracranial venous drainage. MRV without IV contrast is commonly used to confirm absence of flow in a thrombosed dural venous sinus. MRV with IV contrast is less susceptible to the flow artifacts that may occur because of turbulent flow in the dural venous sinuses with noncontrast MRV [80]. Arteriography Cervicocerebral Catheter angiography is not routinely used for the diagnosis of cortical venous or dural venous sinus thrombosis but is used when endovascular treatment is required. US Duplex Doppler Transcranial Head US with Doppler may be used to assess patency of the dural venous sinuses in the neonate. Following closure of the fontanels, CT and MRI are more commonly used. Variant 11: Child. Clinical presentation suggestive of acute stroke, sickle cell disease. New focal fixed or worsening neurologic defect. Initial imaging. SCD constitutes one of the main etiologies of pediatric stroke. Eleven percent of children with SCD not receiving primary stroke prevention therapy will have a stroke by 20 years of age [36,82,83].
Cerebrovascular Disease Child PCAs. Cerebral sinovenous thrombosis can cause elevation in venous pressure, increased intracranial pressure, and venous infarction. Hemorrhagic infarction (40%) and hydrocephalus (10%) may complicate cerebral sinovenous thrombosis [77]. Infarctions are more frequently hemorrhagic in neonates (72%) than in older children (48%) [79]. The lateral dural venous sinuses (73%) and superior sagittal sinus (35%) are most commonly affected [76- 78]. CT Head CT Head Unenhanced CT shows increased density, often accompanied by distension, of the thrombosed sinus or vein [77,80]. CT is less sensitive than MRI for the demonstration of early ischemic infarction but readily shows areas of brain hemorrhage [77,79]. MRV Head MRV is used to diagnose and follow cortical vein and dural venous sinus thrombosis and is typically performed in conjunction with anatomic MRI without and with IV contrast for a comprehensive assessment of the intracranial venous drainage. MRV without IV contrast is commonly used to confirm absence of flow in a thrombosed dural venous sinus. MRV with IV contrast is less susceptible to the flow artifacts that may occur because of turbulent flow in the dural venous sinuses with noncontrast MRV [80]. Arteriography Cervicocerebral Catheter angiography is not routinely used for the diagnosis of cortical venous or dural venous sinus thrombosis but is used when endovascular treatment is required. US Duplex Doppler Transcranial Head US with Doppler may be used to assess patency of the dural venous sinuses in the neonate. Following closure of the fontanels, CT and MRI are more commonly used. Variant 11: Child. Clinical presentation suggestive of acute stroke, sickle cell disease. New focal fixed or worsening neurologic defect. Initial imaging. SCD constitutes one of the main etiologies of pediatric stroke. Eleven percent of children with SCD not receiving primary stroke prevention therapy will have a stroke by 20 years of age [36,82,83].