US Duplex Doppler Carotid Artery In the setting of IPH, US duplex Doppler carotid of the neck is not supported by the literature. US Duplex Doppler Transcranial In the setting of suspected hypertensive hemorrhage, there is no relevant literature to support transcranial Doppler. Variant 7: Adult. Suspected venous sinus thrombosis. Initial imaging. CVT is an uncommon cause for stroke, accounting for approximately 1% to 2% of all strokes [99]. The patients often have hypercoagulable risk factors (cancer, recent oral contraceptive use, and pregnancy) and may present with headaches, seizures, or decreased level of consciousness due to either venous ischemic or hemorrhagic complications. Unlike other stroke etiologies, the presence of ICH is often not a contraindication to anticoagulation but necessitates serial assessment for hematoma expansion in this patient population. Venous infarction and hemorrhage may complicate venous thrombosis, particularly cortical venous thrombosis. Imaging features suggesting venous infarction with hemorrhage may include atypical distributions not matching arterial vascular territories, infarcts with cortical sparing, typical parasagittal or temporoparietal location, or dural venous/cortical venous hyperdensity on noncontrast CT suggestive of thrombus. Arteriography Cervicocerebral Catheter-directed cerebral angiography and runoff venography are infrequently necessary in the setting of dural venous sinus thrombosis due to the sensitivity and specificity of CTV and MRV. In the setting of progressive infarct despite adequate medical therapy, catheter-directed angiography and venography may be useful to assess potential endovascular treatment targets. CT Head Perfusion With IV Contrast Some studies demonstrate a possible role for perfusion imaging in prognostic evaluation of the ischemic penumbra in the setting of CVT [100]. However, perfusion imaging is typically a follow-up imaging study after the diagnosis of CVT.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. US Duplex Doppler Carotid Artery In the setting of IPH, US duplex Doppler carotid of the neck is not supported by the literature. US Duplex Doppler Transcranial In the setting of suspected hypertensive hemorrhage, there is no relevant literature to support transcranial Doppler. Variant 7: Adult. Suspected venous sinus thrombosis. Initial imaging. CVT is an uncommon cause for stroke, accounting for approximately 1% to 2% of all strokes [99]. The patients often have hypercoagulable risk factors (cancer, recent oral contraceptive use, and pregnancy) and may present with headaches, seizures, or decreased level of consciousness due to either venous ischemic or hemorrhagic complications. Unlike other stroke etiologies, the presence of ICH is often not a contraindication to anticoagulation but necessitates serial assessment for hematoma expansion in this patient population. Venous infarction and hemorrhage may complicate venous thrombosis, particularly cortical venous thrombosis. Imaging features suggesting venous infarction with hemorrhage may include atypical distributions not matching arterial vascular territories, infarcts with cortical sparing, typical parasagittal or temporoparietal location, or dural venous/cortical venous hyperdensity on noncontrast CT suggestive of thrombus. Arteriography Cervicocerebral Catheter-directed cerebral angiography and runoff venography are infrequently necessary in the setting of dural venous sinus thrombosis due to the sensitivity and specificity of CTV and MRV. In the setting of progressive infarct despite adequate medical therapy, catheter-directed angiography and venography may be useful to assess potential endovascular treatment targets. CT Head Perfusion With IV Contrast Some studies demonstrate a possible role for perfusion imaging in prognostic evaluation of the ischemic penumbra in the setting of CVT [100]. However, perfusion imaging is typically a follow-up imaging study after the diagnosis of CVT.