Extensive dural venous sinus thrombosis

Case contributed by Dalia Ibrahim
Diagnosis almost certain

Presentation

Postpartum severe headache and disturbed conscious level.

Patient Data

Age: 30 years
Gender: Female
  • Bilateral cerebral (fronto-temporo-parietal) subcortical white matter, bilateral caudate and right thalamic areas of abnormal signal and diffusion restriction eliciting high signal at T2 & FLAIR WI and being of bright signal at DWI and dark signal at ADC map. 
  • Loss of signal void of the superior, inferior sagittal, straight sinuses, internal cerebral veins, right transverse and sigmoid sinuses as well as the proximal examined portion of the right internal jugular vein which appear distended and demonstrate blooming on gradient echo.
  • Multiple dilated venous collaterals are noted.

  • Loss of signal of the superior, inferior sagittal, straight sinuses, internal cerebral veins, right transverse and sigmoid sinuses as well as the proximal examined portion of the right internal jugular vein which appear distended.
  • Markedly attenuated left transverse and sigmoid sinuses, likely recanalized.
  • Patent examined portion of the left internal jugular vein.
  • Multiple dilated venous collaterals are noted.

Case Discussion

Multiple extensive superior & inferior sagittal, straight sinus, internal cerebral veins, right transverse and sigmoid venous sinus thrombosis.

Attenuated left transverse and sigmoid sinuses, likely recanalized.

Bilateral cerebral (frontotemporopareital) and caudate & right thalamic areas of abnormal signal and diffusion restriction, impressive of acute cerebral venous infarcts.

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