Presentation
Headache and convulsions.
Patient Data
A rather defined intra-axial lesion is noted at the right temporal lobe. It displays T2 and FLAIR hyperintense signal with hypointense rim and T1 heterogenous hyperintense signal. No appreciable post-contrast enhancement. On SWI evident blooming seen demoting hemorrhagic changes.
This is associated with mild perifocal edema and mass effect manifested as effacement of the related cortical sulci and occipital horn of the right lateral ventricle.
Thin rim extra-axial hemorrhage about 4 mm seen at the right temporoparietal region.
Mild age-related involutional brain changes.
Thrombosis of the right transverse sinus and sigmoid sinuses.
Case Discussion
MRI features are suggestive of sizable right temporal lobe late subacute hemorrhagic venous infarction sequel to homolateral transverse and sigmoid sinuses thrombosis. Temporoparietal regions are usually affected in transverse / sigmoid sinus thrombosis-related venous infarction.
Venous thrombosis should be considered in the assessment of confluent infarct or hemorrhage in atypical areas, crossing arterial territories, or infarcts with cortical sparing 1.
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