Sensory Aphasia After Cerebral Venous Sinus Thrombosis: Quantitative Evaluation of the Recovery Process of Language Function Using Tractography

Cerebral venous sinus thrombosis (CVST) is a rare condition with high mortality that requires careful imaging evaluation. While arterial spin labeling (ASL) proves valuable for CVST assessment and diffusion tensor imaging (DTI) effectively evaluates language function in stroke, no studies have combined these techniques to assess the progression of higher brain dysfunction in CVST. A 59-year-old man presented with severe sensory aphasia. Magnetic resonance venography (MRV) showed left sigmoid sinus disruption with decreased proximal signal intensity, while conventional MRI showed no ischemic findings. The patient underwent sequential imaging with ASL and DTI using a 1.5 Tesla MRI system (SIGNA Explorer 1.5T, GE Healthcare Japan, Tokyo, Japan). The sensory aphasia was resolved by day two, coinciding with improvement in MRV and normalization of ASL findings. DTI tractography, analyzed using XTRACT auto-segmentation, showed changes in fractional anisotropy (FA) values of language-related white matter tracts that paralleled symptom improvement. Recovery of Chinese character reading and writing corresponded with changes in FA values in the inferior fronto-occipital and inferior longitudinal bundles, reflecting the resolution of venous congestion. This case demonstrates the complementary value of ASL and DTI in monitoring recovery from CVST. While ASL showed increased cerebral blood flow during the acute phase, DTI provided objective measures of functional recovery through changes in FA values in language-related white matter tracts. This combined imaging approach offers a promising method to assess both perfusion changes and functional recovery in CVST with associated higher brain dysfunction.