Subcortical hemorrhage: marker for radiographically occult cerebral vein thrombosis on CT.

OBJECTIVE

Cerebral vein thrombosis (CVT) is a potentially life-threatening entity with a protean clinical presentation that can lead to delays in diagnosis and treatment. Computed tomography of the brain is often the initial imaging tool in evaluation of these patients, but is frequently 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 CVT proven by MRI over a 4 year period was performed. The CT examinations 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 as well as the delay in diagnosis and treatment secondary to unrecognized CVT on CT was also performed.

RESULTS

Subcortical hemorrhage was noted in 9 of 24 (38%) subjects with CVT by MRI. The CT antedated MRI in eight of these subjects as the initial evaluation for presenting neurological symptoms. Subcortical hemorrhage was noted in six of eight of these subjects as the sole CT finding. Subcortical hemorrhage as well as CVT was seen in one subject, and no abnormality was seen in the final subject. Cerebral vein thrombosis was not suggested as a diagnosis 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 investigation by MRI.