Learning objectives
To describe the very rare condition of isolated thrombosis of basal vein of Rosenthal,
to point out the importance of CT and MR as diagnostic tools in detection of this condition and to discuss its potential mimics.
Background
While in the body veins typically accompany arteries,
this does not exist in the brain where intracranial venous system is an articulate network made of veins and sinuses,
lacking of valves with potential bidirectional flow.
Cerebral veins may be subdivided into three subgroups:
1) superficial veins: further subdivided into a superior,
a middle,
and an inferior group draining mainly the upper surfaces of the cerebral hemispheres,
inferior frontal lobes and temporal poles
2) the “deep cerebral” veins: further categorized into medullary,
subependymal and deep paramedian...
Findings and procedure details
Potentially each cerebral vein and dural sinus might be affected by thrombosis: superior sagittal sinus is the most commonly affected,
followed by transverse and sigmoid sinus,
but both superficial (SCVT) and deep cerebral veins thrombosis (DCVT) can occur associated with it.
Thrombosis of deep cerebral veins,
meaning internal veins,
basal veins of Rosenthal,
vein of Galen and its tributaries has been found in 10% of patients [10],
almost always bilateral [1].
Basal vein of Rosenthal are paried paramedian veins,
closely related to the posterior cerebral...
Conclusion
Isolated thrombosis of BVR is a very rare condition.
It remains both an elusive diagnosis due to diversity of causes and clinical presentations,
and a diagnostic challenge for radiologists.
Advanced cross-sectional imaging techniques,
including MR spectroscopy and contrast enhanced MR,
may be helpful in establishing a correct diagnosis.
BVR not exhibited in contrast-enhanced magnetic resonance venography or in MIP images of CT Angiography still remains the diagnostic key finding.
References
[1] Osborn AG,
Hedlund GL,
Salzman KL.
Osborn's Brain.
Elsevier; 2017: 253-269
[2] Saposnik G,
Barinagarrementeria F,
Brown RD,
et al.
Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
Stroke.
2011;42(4):1158-92
[3] Zuurbier SM,
Hiltunen S,
Tatlisumak T,
et al.
Admission Hyperglycemia and Clinical Outcome in Cerebral Venous Thrombosis.
Stroke.
2016;47(2):390-6
[4] Silvis SM,
de Sousa DA,
Ferro JM et al.
Cerebral venous thrombosis.
Nat Rev Neurol 2017; 13: 555-65
[5] Szurowska E,
Szarmach...