braintf4text-venous infarct

BrainTF4-Venous Infarct

Clinical Profile:

C/O seizures.

Findings:

Diffuse hypointense areas on the T1W images which turn hyperintense on the Proton & T2W images are noted in the left parietal lobe. An area which is predominantly hypointense with a hyperintense rim on all sequences is noted in this lesion (subacute blood). The lumen of the superior sagittal sinus shows a hyperintense signal (no flow on the MRV-images not available) representative of a thrombus in this case.

Discussion:

A few causes are:

INFECTION	Mastoiditis Extracerebral empyema Facial/Subgaleal Cellulitis Septicemia Brain abscess Meningitis/Encephalitis
NEOPLASIA	Meningioma Leukemia Meningeal deposits of tumors
TRAUMA	Usually in association with a tear of the wall of the venous sinus
LOW- FLOW STATES	Dehydration/Shock
BLOOD DYSPLASIAS	Sickle cell anemia Polycythemia Vera
MISCELLANEOUS	Post-operative state Diabetes Mellitus with ketoacidosis Chronic debilitating states Tolosa-Hunt syndrome

Patients may present with seizures, paresis, raised intracranial pressure, hyperpyrexia and/or mental features.

On MRI:

Diffuse distribution, not conforming to vascular territories (as seen with arterial infarcts).
Hemorrhage may be present (20%).
May find a lack of the normal flow void within a dural venous sinus (e.g. in the superior sagittal sinus).
Gyral/Wedge shaped enhancement (32%).
May see intense tentorial enhancement (collateral's/venous stasis).
May see dilated transcerebral medullary veins (connecting the superficial cortical veins with the subependymal veins).
In the late stage, there will be encephalomalacic changes.