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AJNR - American Journal of Neuroradiology

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Restricted Diffusion in Bilateral Optic Nerves and Retinas as an Indicator of Venous Ischemia Caused by Cavernous Sinus Thrombophlebitis

J.S. Chen^a, P. Mukherjee^a, W.P. Dillon^a and M. Wintermark^a

^a From the Department of Radiology, Neuroradiology Section, University of California, San Francisco, Calif

View larger version (93K): [in a new window]   Fig 1. A 44-year-old man presented with headaches, chemosis, and visual loss. Clinical impression favored severe periorbital cellulitis and pansinusitis. A, Coronal CT angiography at initial presentation reveals bilateral convexity of the cavernous sinus (arrowheads), consistent with CST. Axial 5-mm-thick maximum intensity projections demonstrate an absence of contrast-filling of the superior ophthalmic veins (stars), which was interpreted as indicating bilateral thrombosis. On the contrary, the proximal ophthalmic arteries (arrows), at the level of the orbital apices, are opacified, as well as some muscular or ciliary branches. B, Follow-up T2-weighted MR image corroborates the diagnosis of severe bilateral orbital cellulitis with proptosis. The postcontrast T1-weighted images show intense enhancement within bilateral cavernous sinuses (arrowheads) and within the orbital fat bilaterally. Axial DWI and the corresponding reduced ADC map demonstrate restricted diffusion in the entirety of the optic nerves bilaterally (arrows). There is also a suggestion of reduced diffusion in the bilateral retina (stars), even if no ADC values could be measured accurately because of partial volume averaging.