Cerebral vein thrombosis

Case contributed by A.Prof Frank Gaillard

Presentation

This young patient presented with gradual onset headache followed by seizures and left sided weakness.

Patient Data

Age: Young adult
Gender: Female
CT

Hyperdense material is present in some of the sulci overlying the right cerebral hemisphere. A hyperdense cortical vein is also present. The superior sagittal sinus, partially imaged, is also hyperdense.

There is minor swelling of the posterior frontal/parietal regions. 

CT

Selected images form a CT venogram obtained at the same time demonstrates extensive venous thrombosis involving not only the anterior two thirds of the superior sagittal sinus but also cortical veins over the surface of the right hemisphere. Axial images demonstrate a so-called 'empty delta' sign.

CT

CT brain 9 hours after admission

Single image from a non-contrast CT demonstrates a right sided venous haemorrhage.

CT

CT brain 18 hours after admission

Single image from a non-contrast CT demonstrates further evolution of the right sided venous haemorrhage. It has a typical mulitlobulated appearance, likened to a garlic bulb. 

Case Discussion

Intracranial venous thrombosis typically presents with gradually increasing headache. It is most frequently seen in patients who are generally hypercoagualable (e.g. oral contraceptive pill, malignancy) or those with adjacent infection (e.g. mastoiditis). 

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Case information

rID: 4408
Case created: 20th Aug 2008
Last edited: 24th Sep 2017
Inclusion in quiz mode: Included

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