CT Brain + CTA and CT Venogram
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There is a small volume of left frontal subarachnoid blood. The overlying left frontal superficial cortical veins and anterior superior sagittal sinus appear hyperdense. No definite intra-axial haemorrhage (possible small petechial component). Grey-white matter differentiation is preserved. No midline shift. No hydrocephalus. No skull fracture or subgaleal haematoma.
Conclusion: Left frontal subarachnoid haemorrhage with findings suggestive of left frontal cortical vein thrombosis with involvement of the frontal aspect of the sagittal sinus.
Whilst this may be an isolated finding an underlying dural AVF warrants exclusion. Emergent evaluation with CTV/CTA COW recommended in the first instance.
There is a filling defect within the anterior superior sagittal sinus and hypoenhancement and additional filling defects in the left frontal superficial cortical veins. The posterior superior sagittal sinus and remainder of the venous sinuses opacify normally.
CTA COW (not shown)
The aortic arch has not been imaged. The right vertebral artery is dominant; the left arises from the arch. The left PCA has a fetal origin. The extracranial vessels, circle of Willis and vertebrobasilar system opacify normally. No evidence of an aneurysm, vascular malformation, dissection or significant stenosis.
Conclusion: Findings are consistent with anterior superior sagittal sinus/left frontal superficial cortical vein thrombosis. No underlying dural AVF identified.