Cerebral venous thrombosis

Case contributed by Dr Foroogh Jafari Mousavi

Presentation

Found face down with frothing. Remains drowsy. Global headache and photophobia.

Patient Data

Age: 20 years old
Gender: Female
Modality: CT

There is marked hyperdensity of the superior sagittal sinus, straight sinus and vein of Galen with the density reaching up to 70HU in the vein of Galen. 

There is no CT appreciable intracranial haemorrhage or established ischemic infarction. The CSF-containing spaces including cisterns and ventricles are symmetrical and age-appropriate. There is no hydrocephalus. There is no midline shift or intracranial mass. 

Conclusion

Marked hyperdensity of the cortical veins, straight sinus, vein of Galen.This is in keeping with venous sinus thrombosis until proven otherwise. Emergency MRI study is recommended.

Modality: MRI

This post contrast T1 study shows filling defects in sagittal sinus, straight sinus, Vein of Galen and internal cerebral veins. Findings are in keeping with extensive dural venous sinuses and deep vein thrombosis.

Case Discussion

This 20 year old female presented with drowsiness and seizure-like spell. 

Initial non-contrast CT showed high density of dural venous sinuses and deep cerebral veins. The differentiation was made by comparing the density of basilar artery and dural venous sinuses, which should be the same on a non-enhanced study.

Subsequently, the patient went on to have contrast enhanced MRI that confirmed the diagnosis of extensive cerebral venous thrombosis. Anti-coagulation was started. The patient was instructed to stop oral contraception medication. No adverse clinical sequelae were observed by the treating team. 

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Case Information

rID: 37224
Case created: 29th May 2015
Last edited: 6th Apr 2017
Inclusion in quiz mode: Included

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