The diagnostic utility of unenhanced computed tomography of the brain and D-dimer levels in acute cerebral venous sinus thrombosis: A quantitative study.

Objectives: (1) To calculate the sensitivity and specificity of the Hounsfield Unit (HU), the HU to hematocrit (H:H) ratio, and the D-dimer level in the diagnosis of acute CVST. (2) To assess the D-dimer level's linear relationship with the HU and the H:H ratio. Materials and Methods: A single-center retrospective case-control study was conducted from 2005 to 2020. The inclusion criteria for the thrombosed and control groups were specified. A region of interest (ROI) was plotted on the respective sinuses to calculate the HU. The H:H ratio was calculated by dividing the HU value by the hematocrit value. The receiver operating characteristic curve was used to calculate the sensitivity and specificity of the HU and the H:H ratio at different cutoff values. The Pearson correlation was used to assess the linear relationship between the D-dimer level and the HU and H:H ratio. Results: There were 19 patients in the thrombosed group and 28 patients in the control group. There were significant differences in the mean HU (71 ± 6.3 vs. 45 ± 4.8, P < 0.001) and the mean H:H ratio (2.11 ± 0.38 vs. 1.46 ± 0.63,P < 0.001). An optimal HU value of 56 yielded 100% sensitivity and specificity. An H:H value of 1.48 yielded a sensitivity of 100% and a specificity of 65%, an H:H ratio of 1.77 demonstrated a sensitivity of 85% and a specificity of 90%, and an H:H ratio of 1.88 yielded a sensitivity of 79% and a specificity of 93%. D-dimer levels had a 95% and 71% sensitivity and specificity, respectively. There was a significant moderately positive linear correlation between the D-dimer level and the HU (r = 0.52, P < 0.001) and the H:H ratio (r = 0.61, P < 0.001). Conclusion: Unenhanced CT of the brain can be a valuable objective diagnostic tool for acute CVST diagnosis. Hounsfield blood density and its normalized ratio with hematocrit are positively correlated with D-dimer levels, which may indicate active blood coagulation in a cerebral venous sinus.

Perinatal atypical teratoid/rhabdoid tumor involving the deep ear structures and complicated by arterial infarction.

Atypical teratoid/rhabdoid tumor is a malignant pediatric brain tumor. Unusual invasive behavior of the dura and bony involvement of the deep ear structures and rapid progression in size complicated by arterial infarction have not been described before. A newborn girl presented with increased intracranial pressure. Medical imaging revealed a large mass centered in the left cerebellopontine angle and left middle cranial fossa with large supra-tentorial components associated with destruction of the left petrous bone with involvement of the inner and middle ear structures. Shortly, the tumor rapidly progressed in size and complicated by left middle cerebral artery territory infarction. The patient passed away after a short hospital course. This case report illustrates how rapid and aggressive the natural history of atypical teratoid/thabdoid tumor can be with unusual skull base destruction and deep ear structures involvement.