Presentation
Found GCS 13 after not being seen for a few days.
Patient Data
Large left intracranial hemorrhage measures up to 53 x 37 mm, and involves the frontal, parietal and temporal lobes, with surrounding vasogenic edema. No subarachnoid or ventricular blood is detected. Significant mass effect, with 7 mm of subfalcine herniation to the right, and effacement of the left lateral ventricle, Sylvian fissure and cortical sulci. No transtentorial or uncal herniation.
A large (6 x 3 x 4 cm) left temporal lobe intra axial lesion demonstrates heterogenous T2 signal, peripheral T1 hyperintensity, and marked T2*GRE susceptibility artefact.
The lesion exerts significant local mass effect with surrounding sulcal effacement. Secondary subfalcine and early transtentorial brain herniation; right subfalcine midline shift (5 mm), mesial temporal lobe shift and cerebral peduncle compression, and mid brain shift.
The left transverse sinus is brightly T1 and T2 hyperintense and the phase-contrast MRV demonstrates complete absence of flow.
Conclusion
Left transverse sinus thrombosis. Associated left temporal lobe hemorrhagic venous infarct with significant mass effect and brain herniation.
Unable to process the form. Check for errors and try again.