Imaging is often helpful in diagnosing CVT.(Gynecology)

Without the information provided by imaging, the differential diagnosis of cerebral venous thrombosis is fairly broad, said Dr. Andrew D. Perron, residency program director in the department of emergency medicine at Maine Medical Center in Portland.

The patient may have ongoing seizures (nonconvulsive status) with a variety of etiologies possible--infectious, tumor, metabolic, or toxic, Dr. Perron said in an interview.

Cerebral venous thrombosis (CVT) disproportionately affects women. Mortality in untreated cases is reported to range from 14% to 48%. The outcome overall is good, particularly with IV heparin therapy, he said.

The MRI shown on the left is from a 22-year-old female graduate student who was taken to the emergency department by her roommate. She had had a headache for 5 days, and over the last 18 hours she had been somnolent with episodes of vomiting. Her right leg began twitching rhythmically and continuously about an hour before her admission to the ED. She had suffered no trauma, recent illness, or previous episodes.

On physical examination the patient was somnolent but aroused to pain, opening her eyes to regard the examiner. She made nonsensical but fluent verbalizations. Her right leg and right abdominal muscles were rhythmically twitching. She could move her arms and legs, but she clearly moved her left extremities more than her right. Bilateral papilledema was present on examination, Dr. Perron said.

The woman had a history of irregular, heavy menses, and she had recently started taking oral contraceptives to regulate her cycle.

When considered together, the recent history of headache, vomiting, twitching of the right leg, impaired movement of extremities on her right side, verbal difficulties, and papilledema strongly suggested CVT. Initial imaging of CVT can be difficult, and the diagnosis may not always be evident on contrast/noncontrast ...