Cerebral venous sinus thrombosis on MRI: A case series analysis

Background: Cerebral venous sinus thrombosis (CVST) is a rare form of stroke seen in young and middle aged group, especially in women due to thrombus of dural venous sinuses and can cause acute neurological deterioration with increased morbidity and mortality if not diagnosed in early stage. Neurological deficit occurs due to focal or diffuse cerebral edema and venous non-hemorrhagic or hemorrhagic infarct. Aim and Objectives: To assess/evaluate the role of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Venography (MRV) as an imaging modality for early diagnosis of CVST and to study patterns of venous thrombosis, in detecting changes in brain parenchyma and residual effects of CVST using MRI. Materials and Methods: Retrospective descriptive analysis of 40 patients of CVST diagnosed on MRI brain and MRV was done. Results: 29/40 (72.5%) were males and 11/40 (27.5%) were females. Most of the patients were in the age group of 21-40 years (23/40-57.5%). Most of the patients 16/40 (40%) presented within 7 days. No definite cause of CVST was found in 24 (60%) patients in spite of detailed history. In 36/40 (90%) of cases major sinuses were involved, deep venous system were involved in 7/40 (17.5%) cases, superficial cortical vein was involved in 1/40 (2.5%) cases. Analysis of stage of thrombus (acute, subacute, chronic) was done based on its appearance on T1 and T2WI. 31/40 (77.5%) patients showed complete absence of flow on MRV, while 9/40 (22.5%) cases showed partial flow on MR venogram. Brain parenchyma was normal in 20/40 (50%) patients while 6/40 (15%) cases had non-hemorrhagic infarct and 14/40 (35%) patients presented with hemorrhagic infarct. Conclusion: Our study concluded that MRI brain with MRV is sensitive in diagnosing both direct signs (evidence of thrombus inside the affected veins) and indirect signs (parenchymal changes) of CVST and their follow up

High diagnostic value of gradient echo sequence in isolated cortical vein thrombosis

Isolated cortical vein thrombosis is quite less common than dural venous sinus thrombosis. Its diagnosis is difficult and needs high index of suspicion clinically and on magnetic resonance imaging (MRI). A 38-year-old man presented with the history of three episodes of generalized seizures and weakness and sensory loss in the both upper limbs with headache. MRI brain with magnetic resonance venography (MRV) was performed. MRI brain showed hemorrhagic infarcts in bilateral frontoparietal region. Gradient echo sequence showed hypo-intense signal within thrombosed cortical veins. MRV showed paucity of cortical veins in involved areas suggestive of cortical vein thrombosis

Deep vein thrombosis of the lower limbs: A retrospective analysis of doppler ultrasound findings

Background: Deep venous thrombosis (DVT) of lower limbs is one of the most common cause for the majority of deaths caused by pulmonary embolism. Many medical and surgical disorders are complicated by DVT. Most venous thrombi are clinically silent. B-mode and color Doppler imaging is needed for early diagnosis of DVT to prevent complications and sequalae of DVT. Aim and Objectives: The objectives of the following study were to evaluate the role of Doppler as an imaging modality in diagnosing DVT of lower limbs, to study the spectrum of findings on Doppler ultrasound in patients with DVT. Materials and Methods: Retrospective descriptive analysis of 78 patients of DVT diagnosed on Doppler. Results: Nearly 74% of the patients were males and 26% were females with majority belonging to fifth decade (26%). 75 (96.1%) cases showed unilateral while 3 (3.9%) cases showed bilateral lower limb involvement. In our study, predominant distribution of thrombus was found to be in above knee region with 69/78 (88.5%) patients having thrombus in the superficial femoral vein. Popliteal vein was involved in 54/78 (69.2%) patients. Complete thrombosis was observed in 54/78 (69%) cases, while partial thrombosis was observed in 24/78 (31%) cases. Subacute stage was seen in 42 cases (53.8%), acute stage in 23 cases (29.5%) while chronic stage in 13 cases (16.7%). 71 cases (91%) had multiple contiguous segmental involvement, whereas 7 cases (9%) had isolated vein involvement. Conclusion: Color Doppler is useful in diagnosing DVT in symptomatic and at risk patients and provides a non-invasive method of investigation. It is also helpful in evaluating the site, extent and stage of thrombus

Quadrigeminal cistern lipoma: A rare case report with review of literature

Two cases, one of a 6-old-year male and another of 18-year-old female with an intracranial lipoma of quadrigeminal region is reported. Intracranial lipomas usually occur in midline areas and are extremely uncommon with an incidence of 0.1% of all intracranial tumors. These were incidentally detected by computed tomography (CT) or by autopsy. Autopsy incidence of intracranial lipoma is 0.08-0.46%, while incidence of CT findings is not >0.03-0.06%. CT and magnetic resonance imaging (MRI) examination usually lead to the diagnosis, because of the very low attenuation values of lipomas on CT and the short T1 and T2 on magnetic resonance. We describe the findings of imaging studies, including CT, MRI along with a brief review of the literature

Role of imaging in Mayer-Rokitansky-Kuster-Hauser syndrome

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by congenital absence of the uterus and upper 2/3 rd of vagina with a normal 46, XX karyotype and normally developed secondary sexual characteristics. It affects 1:4000 women. It may be isolated (Type I) or frequently associated with renal, vertebral anomalies and less frequently associated with auditory, cardiac defects (Type II). It presents with primary amenorrhea in young women with normal external genitalia and normal development of secondary sexual characteristics with normal functioning ovaries and karyotype 46, XX without visible chromosomal anomaly. It was considered as sporadic anomaly but an increasing number of familial cases is suggestive of genetic cause in whom it is transmitted as autosomal dominant trait with incomplete penetrance and variable expressibility. This is suggestive of involvement of mutation in a major development gene or a limited chromosomal imbalance. Etiology of MRKH syndrome is still unclear. In order to allow sexual intercourse, treatment is aimed at creation of neovagina. Patients and their families must attend counseling before and throughout treatment as psychological distress is very important in young women with MRKH. We hereby report a rare case of MRKH syndrome in a 19-year-old married female patient presenting with primary amenorrhea, coital difficulty and no other clinical disorder