Cerebral venous sinus thrombosis

Case contributed by Nikos Karapasias
Diagnosis certain


Epileptic seizures, left hemiparesis, consciousness disturbance and visual-spatial disorders. The individual medical record of patient notes diabetes mellitus, arterial hypertension and surgery for colorectal cancer done 20 years ago. From laboratory results may be worth note the hematocrit of 49.90%

Patient Data

Age: 85 years
Gender: Female

Irregularly shaped hemorrhage in the right parietal lobe on the edge of white and gray matter.  Parenchymal hemorrhage can be seen in one-third of cases of cerebral venous thrombosis.

Abnormal hyperattenuation consistent to direct visualization of a clot in the straight sinus on a non-enhanced CT scan (dense clot sign) (in 1/3 of cases)

Note the hyperdense presentation of superior sagittal sinus (dense delta / filled triangle sign). This is not specific and can be observed occasionally in patients with an elevated hematocrit.

Contrast-enhanced CT image shows a central filling defect in the SSS, surrounded by intensely enhanced dura mater (empty delta / empty triangle sign). It is seen in 25–52% of patients with sagittal, straight, and lateral sinus thrombosis.

View the difference on CT scan after 30 days.

Case Discussion

Intracranial venous thrombosis may occur at any time from infancy to old age (most often affects young adults and children). Is a relatively uncommon but serious neurologic disorder that is potentially reversible with prompt diagnosis and appropriate medical care.

It is a difficult diagnosis because of its nonspecific clinical presentation and subtle imaging findings. In about a quarter of the patients with CVST the cause remains unknown.

Worth mentioning the age of the particular patient (CVST is uncommon in older ages).

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