Hyperacute Venous Stroke: CT Perfusion
Hyperacute Venous Stroke: CT Perfusion
Search Pattern Assist ?History
Exam
Purpose
2. Recognize evidence of the actual venous stroke (focal low or absent CBV); the stroke zone, however, is often obscured by the changes related to collateral venous egress or parenchymal vasogenic edema making detection of venous stroke less evident in venous stroke compared to arterial stroke.
3. Recognize dural CVT by the effect of dural wall collateralization (increase TTP and normal or low CBV) or by the lack of collateralization and lack of flow (absent TTP and absent CBV).
4. Recognize CT perfusion changes of pial hyperemia associated with CVT. This can occur on either side of a dural sinus or on just one side because of compartmentalized channels within a dural sinus.
5. The included CTA (included in our CVT protocol) mainly images arterial filling and delayed opacification may simulate CVT.
6. Be aware that intercurrent seizure activity can produce focal high flow regions. This is especially true if there has been hemorrhagic conversion. In this case, the venous egress is into expected dural sinuses rather than altered pathways.
Prior Study
Findings
Initial Evaluation (Technical Aspects)
There is artifact associated with patient motion. [Yes/No]
There is artifact associated with poor cardiac output-low contrast between normal and abnormal tissue. [Yes/No]
There is artifact associated with problematic contrast injection. [Yes/No]
Evidence of Altered Venous Collateral Egress Either Fast Flow into Collateral Routes, or Slower Flow from Venous Congestion
There is faster blood flow in a recognizable venous collateral egress territory with shortened TTP, prolonged MTT and increased or normal CBV and CBF. This egress collateral will typically exit into unusual dural sinuses (i.e. sphenoparietal sinus, cavernous sinus, pharyngeal plexus, interior petrosal sinus, etc). [Yes/No]
There is slower blood flow with increased CBV in areas adjacent to the sites of CVT, which are consistent with venous congestion (expanded venocapillary pool) caused by downstream egress obstruction. This can be associated with elevated cerebral pressure. [Yes/No]
There is prolonged TTP (with dural wall collateralization) or absent TTP/CBV/CBF (thrombosis without dural wall collateralization) within one or more thrombosed dural sinuses. [Yes/No]
Evidence of Thrombosed Major Cortical Vein(s)
There is prolonged TTP with variable (most often close to normal) CBV & CBF confined to a major supratentorial cortical (frontal,Trolard, Labbe’, superior sylvian complex) vein(s). [Yes/No]
There is prolonged TTP with variable (most often close to normal) CBV & CBF confined to a specific major infratentorial cortical (petrosal vein, cerebellar hemispheric, superior or inferior vermian) vein(s). [Yes/No]
There is shortened TTP with variable (most often close to normal) CBV & CBF confined to a specific major infratentorial cortical (petrosal vein, cerebellar hemispheric, superior or inferior vermian) vein(s). [Yes/No]
There is prolonged TTP with variable (most often close to normal) CBV and CBF confined to the deep central veins (ICV, vein of Galen). [Yes/No]
There is CT perfusion evidence of hemorrhagic transformation. [Yes/No]
There is CT perfusion evidence of seizure related hyperemia, especially in the context of brain hemorrhage. [Yes/No]
Evidence of Thrombosed Cavernous Sinus
There is evidence of cavernous sinus thrombosis with reduced blood flow within the cavernous sinus and its efferent output veins. There may be congestion within its afferent input veins. [Yes/No]
There is increased CBV in the cavernous sinus consistent with re-routed venous collateralization through the superior sylvian vein/sphenoparietal sinus/ cavernous sinus/retropharyngeal pathway). [Yes/No]
There is thrombosis of the cavernous sinus related to nasopharyngeal or central skull base infection or infiltrative mass. [Yes/No]
Other
There are other findings are present consistent with a disorder other than CVT. [Yes/No]
Impression
Hyperacute Stroke - Venous, Diagnostic: CT Perfusion
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Continue with venous thrombosis protocol CTV or MR with MRV as needed.
