Preliminary Diagnosis: Sigmoid Sinus Thrombosis
I. What imaging technique is first-line for this diagnosis?
CT venography of the brain.
II. Describe the advantages and disadvantages of this technique for diagnosing sigmoid sinus thrombosis.
Advantages
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Relatively inexpensive, fast imaging modality.
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Better able to evaluate the surrounding osseous structures than other imaging modalities.
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Disadvantages
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Exposes the patient to ionizing radiation.
III. What are the contraindications for the first-line imaging technique?
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May be contraindicated in pregnant patients.
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Relative contraindication in patients with renal failure.
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Relative contraindication in pateints with contrast allergy.
IV. What alternative imaging techniques are available?
MR venography of the brain.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing sigmoid sinus thrombosis.
Advantages
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Offers exquisite detail of the dural venous sinuses and is more sensitive and specific to diagnose dural venous inus thrombosis.
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Better able than CT to evaluate the adjacent brain parenchyma for any abnormality.
Disadvantages
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Expensive.
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Time consuming.
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Requires significant patient cooperation to minimize motion artifact.
VI. What are the contraindications for the alternative imaging techniques?
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Contraindicated in patients with non-MR compatible hardware.
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Gadolinium contrast is contraindicated in patients with a GFR ≤ 30.
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