Monitoring of venous hemodynamics in patients with cerebral venous thrombosis by transcranial Doppler ultrasound

Objectives: To test the assumption that transcranial Doppler ultrasound (TC D) is able to detect and to monitor intracranial venous blood flow velociti es in patients with confirmed cerebral venous thrombosis (CVT). Design: Prospective case study in 18 patients. Setting: Inpatient neurologic service in a university hospital. Subjects and Methods: Serial TCD examinations were performed in 18 consecut ive patients with CVT (14 females, 4 males) aged 16 to 64 years (mean +/- S D, 36.8 +/- 13.1 years) during a mean follow-up ranging from 34 to 783 days (mean +/- SD, 201 +/- 185 days) between 1993 and 1997. Venous TCD was perf ormed with a 2-MHz range-gated transducer. Results: Venous blood flow velocities were successfully measured in all pat ients. The highest measured velocities in the monitored intracranial venous vessels ranged from 20 to 150 cm/s (mean +/- SD, 58.9 +/- 38.8 cm/s),and t he lowest were from 9 to 84 cm/s (mean +/- SD, 27.9 +/- 17.0 cm/s). Fifteen patients (83%) showed a decrease of velocities-2 of them after a transient increase during cessation of heparin therapy. The percentage of velocity d ecrease ranged from 34% to 73% (mean +/- SD, 56.4% +/- 10.9%). A plateau ph ase, defined as no further decrease in velocities, was reached in these pat ients within 4 to 314 days (mean +/- SD, 59.9 +/- 73.7 days). Three patient s (17%) showed no changes in velocities as defined by a limit of velocity v ariation of 30% during the course of CVT. High venous velocities were signi ficantly associated with altered consciousness (P =.001). A nonsignificant relationship was observed with affliction of the superior sagittal sinus. N o correlations were noted for onset of disease, initial motor deficits, and presence of bleeding. No predictive value was gained from analyzing the ou tcome in relation to absolute velocities or their decrease. Conclusions: Serial TCD studies allow monitoring of venous hemodynamics and collateral pathways in patients with CVT. Normal venous velocities in seri al measurements, however, do not exclude a diagnosis of CVT.