Hyperacute Venous Stroke: MR T2 or FLAIR
Hyperacute Venous Stroke: MR T2 or FLAIR
Search Pattern Assist ?History
Exam
Purpose
2. Assess the FLAIR sequences for parenchymal edema in a recognizable dural sinus thrombosis, in which case the edema is likely on both sides of the affected dural sinus.
3. Assess for positive FLAIR signal in the walls of recanalized cortical veins, the dural sinus walls, or the outer dura itself.
4. Assess for global or hemisheric swelling, since CVT can produce either pseudotumor type of brain swelling, if extensive enough.
5. Assess for evidence of dilatation of the intraorbital veins, and optic hydrops (dilated CSF space around the optic nerves), which is indicative of raised ICP.
6. FLAIR is the best means of detecting early hydrocephalus, because it not only detects early ventriculomegaly, but also evidence of transepenymal fluid, effacement of sulci, increased protein in sulci. These feature help distinguish early CSF pressure elevation from chronic, incidental, ventriculomegaly.
Prior Study
CTA/MRA Head and Neck
MR T1-W SequencesMR Diffusion Sequences
Findings
MR T2 or FLAIR
There is positive FLAIR in a recognizable dural sinus and possibly its input venous confluences indicating dural sinus CVT. [Yes/No]
There is abnormal FLAIR (can be positive or negative signal) in a recognizable cortical or deep central vein egress zone indicating CVT. [Yes/No]
There is regional thickening of the dura (positive FLAIR) consistent with expanded venous plexus within the dural wall related to dural venous collateralization, or generalized dural thickening related to raised intracranial pressure. [Yes/No]
There is abnormal FLAIR signal in a site of positive MR diffusion venous infarct. [Yes/No]
There is hemorrhagic conversion on FLAIR or T2-w. [Yes/No]
There is positive sulcal FLAIR indicating protein leak or subacute SAH. [Yes/No]
There is positive parenchymal FLAIR indicating post CVT ischemic leukomalacia. [Yes/No]
There is evidence of sufficient brain swelling or hemorrhage to produce a brain shift and/or herniation. [Yes/No]
There is evidence of abnormal ventriculomegaly plus FLAIR evidence of transepenymal fluid, effacement of sulci, increased protein in sulci consistent with early hydrocephalus rather than atrophy. [Yes/No]
There is evidence of abnormal widespread dilated cortical veins (especially on T2-w) consistent with dural AVM with venous outlet obstruction. [Yes/No]
There is evidence of optic hydrops and/or edema in the retroglobal soft tissues. [Yes/No]
Other
Other findings are present consistent with a disorder other than CVT.
[Yes/No]
Impression
Hyperacute Stroke - Venous, Diagnostic: MR T2 or FLAIR
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Continue with venous thrombosis protocol MR/MRV
