Cerebral vein thrombosis

Case contributed by 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

Selected axial CT images of the brain demonstrate hyperdense material 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 brain 9 hours after admission

ct

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

CT brain 18 hours after admission

ct

Single image from a non-contrast CT demonstrates further evolution of the right sided venous hemorrhage. 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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