Hyperacute Venous Stroke: MR SWI

History

Recent neurologic changes, often not focal.

Exam

Head MR Susceptibility (SWI) Sequence

Purpose

1. Need to identify sites of cortical vein thrombosis based on SWI blooming artifact.

2. Need to identify venous pial collateral found adjacent to the actual venous occlusion based on the presence of serpiginous dilated cortical veins which flow in opposite direction than normal and in doing so reverse their size from increasing in size as they approach and dural sinus to a reduction in expected size.

3. Need to assess for status of the deep central venous system. If there is venous congestion (CVT in the the vein of Galen, ICV(s), or straight sinus) assess the severity grade, which reflects the extent of available central veneous collateralization.

4. Need to assess the patency of the dural sinuses. This is often less obvious, because of bone artifact, since most dural sinus are adjacent to the skull.

5. Need to detect hemorrhagic conversion.

6. Need to assess for arterial blooming artifact, since some cases have concurrent arterial and venous thrombosis problems.

Prior Study

CT Head
CTA/MRA Final Impression
MR T1-W With and or Without Contrast
MR Diffusion/FLAIR
MR T2-W and /or FLAIR
MR SWI

Findings

MR SWI

There is SWI evidence of venous stasis/congestion and/or SWI blooming artifact within one of more cortical veins. [Yes/No]

There is SWI blooming artifact in a dural sinus. [Yes/No]

There is SWI blooming artifact within a site of hemorrhagic conversion or sequestered infarction or within the sulci/cisterns (SAH). [Yes/No]

There is SWI evidence of venous congestion within deep venous system (4 grades) related to venous egress block at the vein of Galen or straight sinus. [Yes/No]

There is SWI evidence of subcortical venous stasis or venous collapse. [Yes/No]

There is evidence of venous stasis to produce (hopefully early) malignant brain swelling or the possibility of malignant brain swelling. [Yes/No]

There is hyperemic physiologic vasodilation in local venous collateral or in re-routed venous egress including pial/dural anastomotic sites (i.e. vertex venous lacunae, tenorial confluences, or cavernous sinus/retropharyngeal venous plexus). [Yes/No]

There is SWI blooming artifact in a proximal artery. [Yes/No]

Other

Other findings are present consistent with a disorder other than CVT. [Yes/No]

Impression

Hyperacute Stroke - Venous, Diagnostic: MR SWI

Continue with venous thrombosis protocol MR/MRV