SUBCORTICAL HEMORRHAGE - MARKER FOR RADIOGRAPHICALLY OCCULT CEREBRAL VEIN-THROMBOSIS ON CT

Objective: Cerebral vein thrombosis (CVT) is a potentially life-threat ening entity with a protean clinical presentation that can lead to del ays in diagnosis and treatment. Computed tomography of the brain is of ten the initial imaging tool in evaluation of these patients, but is f requently nondiagnostic. This study identifies subcortical hemorrhage (SCH) as an indicator of radiographically occult CVT on CT. Materials and Methods: A retrospective analysis of all subjects (n = 24) with CV T proven by MRI over a 4 year period was performed. The CT examination s of all subjects were evaluated for the presence of SCH and signs of CVT. An evaluation of the correlation between findings on CT and MRI a s well as the delay in diagnosis and treatment secondary to unrecogniz ed CVT on CT was also performed. Results: Subcortical hemorrhage was n oted in 9 of 24 (38%) subjects with CVT by MRI. The CT antedated MRI i n eight of these subjects as the initial evaluation for presenting neu rological symptoms. Subcortical hemorrhage was noted in six of eight o f these subjects as the sole CT finding. Subcortical hemorrhage as wel l as CVT was seen in one subject, and no abnormality was seen in the f inal subject. Cerebral vein thrombosis was not suggested as a diagnosi s in any of the six subjects with SCH as the sole radiographic finding . In all six of these cases, a delay in diagnosis occurred pending MRI obtained subsequently secondary to clinical deterioration. Conclusion : Subcortical hemorrhage can be seen in association with acute CVT and can be the sole abnormality on head CT. SCH as an isolated finding on CT suggests the possibility of unrecognized CVT, warranting further i nvestigation by MRI.