Diagnostic accuracy of plain computed tomography in detecting acute cerebral venous sinus thrombosis keeping magnetic resonance venography as gold standard.

OBJECTIVE: To determine the diagnostic accuracy of plain computed tomography using the ratio between hounsfield unit and haematocrit of cerebral venous sinuses in cases of acute cerebral venous sinus thrombosis taking magnetic resonance venography as the gold standard. METHODS: The cross-sectional validation study was conducted at the Department of Diagnostic Radiology, Combined Military Hospital, Rawalpindi, Pakistan, from March 9 to September 8, 2021, and comprised patients regardless of age and gender presenting with acute neurological and visual signs and symptoms of cerebral venous sinus thrombosis for <5 days. The patients were brain-imaged on 128-slice computed tomography scanner, and the image was assessed and the attenuation values in terms of Hounsfield unit of dural venous sinuses were calculated by taking appropriate region of interest. Haemoglobin and haematocrit values were noted from blood reports, and then the ratio between Hounsfield unit and haematocrit ratio was calculated. Magnetic resonance venography of the patients were performed and the patients were assessed for dural venous thrombosis. Data was analysed using SPSS 23. RESULTS: Of the 201 patients, 98(48.8%) were males and 103(51.2%) were female. The overall mean age was 35.32±19.707 years (range: 1 month-70 years). According to the Hounsfield unit-haematocrit ratio, acute cerebral venous sinus thrombosis was detected in 173(86.01%) patients, while magnetic resonance venography detected 178(88.6%). The Hounsfield unit-haematocrit ratio had sensitivity 91.01%, specificity 52.17% and diagnostic accuracy 86.57%. CONCLUSIONS: Computed tomography attenuation value and Hounsfield unit-haematocrit ratio on unenhanced computed tomography could be used as a reliable method to detect acute cerebral venous sinus thrombosis in emergency settings.

MRI Findings In Acute Wernicke's Encephalopathy, Caused By Hyperemesis Gravidarum.

A 25-year old pregnant female with history of confusion and drowsiness for 02 days was referred by neurophysician for MRI brain. MRI demonstrated T2W/FLAIR hyper intensities in medial thalami, periaqueductal areas with variable diffusion restriction, apparent as hyper intense signal on DWI and no signal change on ADC mapping that was typically consistent with Wernicke's encephalopathy. A high index of suspicion is necessary, as delayed or lack of treatment can lead to high morbidity and mortality.