Cerebral Venous

Thrombosis
 QUESTION 1

Which of the following statements regarding etiologic factors

of cerebral venous thrombosis
(CV T) is TRUE?

A . In adults, the most important cause is infection .

B. When CV T is associated with pregnancy and puerperium, the

risk is highest during the third trimester.

C. Increasing age is a risk factor.

D. In a large proportion of cases, the causes cannot be

identified.
 SOLUTION TO QUESTION 1

 Infection contributes to fewer than 10% of cerebral venous

thrombosis (CV T) cases in adults. Option A is not the best
response. CV T occurs more often in puerperium than during
the pregnancy. Option B is not the best response.
 Although pregnancy -related CV T occurs more often
in older women, aging per se is not a risk factor. Option C is
not the best response. In 20 –35% of cases, the cause remains
unknown, so one should remain suspicious even in the
absence of known risk factors. Option D is the best response.
The pathogenesis of CV T is complex and cause is
multifactorial.
 QUESTION 2

All of the following are clinical presentations

closely associated with CV T EXCEPT:

A . Chronic headache.

B. Altered mental status.

C. Subdural hemorrhage

D. Focal neurologic deficits.

 SOLUTION TO QUESTION 2

 Common presentations include headache, focal neurologic

deficits, seizures, and altered consciousness. Options A, B,
and D are not the best responses. A syndrome of intracranial
hypertension (headache and papilledema) accounts for 40%
of cases in a series, so CV T needs to be excluded in patients
considered for the diagnosis of benign intracranial
hypertension.
 Although subdural hemorrhage has not been associated
 with CV T, cases of subarachnoid hemorrhage as a rare
 presentation of CV T have been reported. Option C is
the best response. There is also a wide distribution in the
mode of onset of symptoms, with approximately 28% acute
(< 48 hours), 42% subacute (between 48 hours and 30 days),
and 30% chronic (> 30 days) presentation [1]. Option A,
which is true, is not the best response. The teaching point is
that CV T may present with an atypical presentation or even
an absence of clinical symptoms.
 QUESTION 3

Direct and indirect signs of CV T on CT include all of the

following EXCEPT:

A .Hemorrhagic cerebral infarction sparing the cortex, but

involving the subcortical region .

B. The empty delta sign on unenhanced CT.

C. Enhancement of the falx and tentorium on contrast

enhanced CT.

D. A “dense clot sign” on unenhanced CT.

 SOLUTION TO QUESTION 3
An infarction not conforming to a major ar terial vascular territor y,
such as the presence of multiple isolated lesions, involvement of the
subcor tical region with sparing of the cor tex , or extension over more
than one ar terial distribution, is highly suspicious for a venous cause.
The infarction may be hemorrhagic or non hemorrhagic. Option A is
not the best response. The empty delta sign may be seen on contrast -
enhanced CT and represents a filling defect (thrombus) in the dural
sinus, with peripheral enhancement possibly secondar y to the
development
of collaterals. The empty delta sign may be seen 5 days to 2 months
from onset . Option B is the best response.
Indirect evidence of CV T may be seen as contrast enhancement
of the falx and tentorium, secondar y to venous stasis
and hyperemia of the dura mater. This is seen in approximately
20% of cases. Option C is not the best response. The “dense
clot sign” and the dense cord sign represent direct visualization
of the thrombosed cor tical vein or the venous sinus in shor t
and long axes, respectively, but are seen in only one third of
cases. Option D is not the best response.
 QUESTION 4

 Which cerebral venous thrombosis presents with hemiparesis,

seizure, papilledema and involvement of 9 th , 10 th and 11 th
Cranial nerve

 A . cortical vein thrombosis

 B. Superior Sagittal Venous Thrombosis

 C. Transverse Sinus Thrombosis

 D. All of Above
 SOLUTION TO QUESTION 4

 Correct Answer is C.
 With cavernous sinus involvement ophthalmoplegia
papilledema first division Trigeminal Nerve show reduce
sensation.
 In Superior Sagittal Sinus headache Papilledema and
seizures motor and sensory deficit of lower limbs occur.
 Cortical vein Thrombosis produce Cortical deficits like
Aphasia, Hemiparesis and epilepsy according to area
involve.