Deep medullary vein engorgement and superficial medullary vein engorgement: two patterns of perinatal venous stroke
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Deep medullary vein engorgement and superficial medullary vein engorgement: two patterns of perinatal venous stroke Hedieh Khalatbari 1 & Jason N. Wright 1 & Gisele E. Ishak 1 & Francisco A. Perez 1 & Catherine M. Amlie-Lefond 2 & Dennis W. W. Shaw 1 Received: 29 April 2020 / Revised: 8 August 2020 / Accepted: 8 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Perinatal venous stroke has classically been attributed to cerebral sinovenous thrombosis with resultant congestion or thrombosis of the small veins draining the cerebrum. Advances in brain MRI, in particular susceptibility-weighted imaging, have enabled the visualization of the engorged small intracerebral veins, and the spectrum of perinatal venous stroke has expanded to include isolated congestion or thrombosis of the deep medullary veins and the superficial intracerebral veins. Congestion or thrombosis of the deep medullary veins or the superficial intracerebral veins can result in vasogenic edema, cytotoxic edema or hemorrhage in the territory of disrupted venous flow. Deep medullary vein engorgement and superficial medullary vein engorgement have characteristic findings on MRI and should be differentiated from neonatal hemorrhagic stroke. Keywords Deep medullary vein . Infants . Magnetic resonance imaging . Neonate . Stroke . Superficial medullary vein . Thrombosis
Introduction The importance of disrupted venous flow as a cause of perinatal ischemic stroke is increasingly recognized [1, 2]. Disrupted venous flow caused by venous congestion and thrombosis can involve the small or large vessels of the superficial or deep cerebral venous systems. Isolated congestion or thrombosis of the large vessels of the superficial cerebral venous system, such as the superior sagittal sinus, typically does not result in venous ischemic stroke because the venous blood is drained by alternative venous pathways. However, when the congestion or thrombosis extends to involve the small intracerebral vessels, a spectrum of events
* Hedieh Khalatbari [email protected] 1
Department of Radiology, University of Washington School of Medicine, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
2
Department of Neurology, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA
ensues in the cerebrum that variably includes vasogenic edema, cytotoxic edema and hemorrhage (petechial hemorrhages and larger hematomas) [3–6]. Thus, congestion or thrombosis of the cerebral venous system might involve only the large vessels, both the large and small vessels, or only the small vessels. The resultant disruption of blood flow in the cerebral venous system results in several patterns of involvement: (a) isolated superficial cerebral sinovenous thrombosis (CSVT), (b) superficial CSVT associated with engorgement of the pial veins and superficial intracerebral veins, (c) deep CSVT associated with engorgement of the deep medullary veins and subependymal veins, (d) engor
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