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Rapid diagnosis of cerebral sinovenous thrombosis complicating group B streptococcus meningitis by multidetector CT venography

H M Cheung¹, W C W Chu², H S Lam¹, P C Ng¹

¹ Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong
² Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, The Chinese University of Hong Kong

Correspondence to:
pakcheungng{at}cuhk.edu.hk

A full-term infant delivered vaginally developed fever and refractory seizures at 34 h of age, ultimately requiring thiopentone anaesthesia. Cerebrospinal fluid and peripheral blood cultures isolated Streptococcus agalactiae. Urgent plain cranial CT revealed a hypo-attenuated area in the left occipital region (fig 1). A multidetector computed tomographic (MDCT) venogram showed a large filling defect almost totally obliterating the left cerebral transverse sinus (fig 2) and confirmed the diagnosis of sinovenous thrombosis with venous infarction of the drainage territory.

View this figure (76K): in this window | in a new window | PowerPoint for Teaching   Figure 1 CT brain scan showing a hypo-attenuated area in the left occipital region (arrows). The appearance is highly suggestive of venous infarction.

 

View this figure (81K): in this window | in a new window | PowerPoint for Teaching   Figure 2 Multidetector computed tomographic venogram showing filling defect (arrow) representing a giant thrombus within the left transverse sinus.

 

In the past, early diagnosis of cerebral sinovenous thrombosis was hampered by the need for invasive angiography and insensitive neuroimaging techniques.^{1 2} MDCT venography, with the capability of submillimetre slices, excellent multiplanar reconstruction and volume rendering programme, is a sensitive investigation for delineating anatomical lesions and the patency of cerebral vessels or sinuses. Although magnetic resonance venography (MRV) also provides excellent image quality,³ and the lack of radiation is a major advantage, it would be impracticable and dangerous to subject critically ill infants to this procedure because of the prolonged scanning time (especially neonates with slow venous flow and small venous channels) and the requirement for heavy sedation.² MDCT venography is comparable to gadolinium-enhanced MRV in visualising all stages of thrombus formation and is a viable alternative to MRI. Early diagnosis of cerebral sinovenous thrombosis and venous infarction by modern neuroimaging techniques can lead to prompt anticoagulant therapy and predicts neurodevelopmental outcomes for parental counselling.^{1 3}

This article has been adapted from Cheung H M, Chu W C W, Lam H S, Ng P C. Rapid diagnosis of cerebral sinovenous thrombosis complicating group B streptococcus meningitis by multidetector CT venography Archives of Disease in Childhood - Fetal and Neonatal Edition 2008;93:304

Competing interests: None.

Patient consent: Informed consent was obtained for the publication of the case details in this report.

1. deVeber, G, Andrew, M, Adams, C, et alCerebral sinovenous thrombosis in children. N Engl J Med 2001;345:417–23.[Abstract/Free Full Text]
2. Shroff, M, & deVeber, GSinovenous thrombosis in children. Neuroimag Clin N Am 2003;13:115–38.[CrossRef]
3. Fitzgerald, KC, Williams, LS, Garg, BP, et alCerebral sinovenous thrombosis in the neonate. Arch Neurol 2006;63:405–9.[Abstract/Free Full Text]

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