Practice Rational imaging

Investigating suspected cerebral venous thrombosis

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39154.636968.47 (Published 12 April 2007) Cite this as: BMJ 2007;334:794
  1. R Smith, specialist registrar,
  2. M D Hourihan, consultant neuroradiologist
  1. University Hospital of Wales, Cardiff CF14 4XW
  1. Correspondence to: M D Hourihan hourihanmd{at}cf.ac.uk

    This series provides an update on the best use of different imaging methods for common or important clinical presentations. The series editors are Fergus Gleeson, consultant radiologist, Churchill Hospital, Oxford, and Kamini Patel, consultant radiologist, Homerton University Hospital, London

    The patient

    A previously well 22 year old woman presented acutely to the accident and emergency department with collapse after several days of insidious onset headache. No focal neurological signs were seen, but she was sleepy, with generalised apathy. The remainder of the clinical examination was normal. As the patient's father had factor V Leiden deficiency, she was referred for imaging to detect cerebral venous thrombosis.

    Learning points

    • Imaging plays a key role in diagnosing cerebral venous thrombosis, a condition that can be mimicked by several other neurological entities

    • Prompt diagnosis and anticoagulation affects patients' outcome

    • Diagnostic imaging of cerebral venous thrombosis depends on which modality is readily available, and local experience in image interpretation

    • CT venography is a sensitive, quick investigation that can be performed immediately after unenhanced CT, reducing time to diagnosis and treatment

    What tests should I order?

    Cerebral venous thrombosis is an uncommon but important diagnosis, as it is potentially reversible when promptly recognised and treated. Diagnosing this condition, which accounts for <1% of …

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