Cerebral venous thrombosis with secondary intracranial hypertension

Case contributed by Dr Ammar Haouimi

Presentation

Sudden onset of severe headaches, with altered consciousness.

Patient Data

Age: 25 years
Gender: Female

The MRI sequences demonstrate:

  • area of venous hemorrhagic infarct in the right frontoparietal region of high signal on T1 and T2 with blooming on the GE sequence, and surrounding edema. Areas of venous infarct are noted in the left temporal and frontal regions
  • thrombosis of the superior sagittal sinus, right lateral and sigmoid sinuses, the ipsilateral internal jugular vein as well as small cortical veins, which appear iso-to high signal on T1, low signal onT2 with loss of their signal void on MRV 2D-TOF.

Signs of secondary intracranial hypertension are well-demonstrated on axial T2 fat sat:

  • vertical tortuosity of the optic nerves
  • mild enlarged subarachnoid space around the optic nerves
  • flattening of the posterior sclera bilaterally
  • enlargement of the Meckel cave
  • partially empty sella

Case Discussion

MRI features of cerebral venous thrombosis (CVT) with venous hemorrhagic infarct and secondary intracranial hypertension.

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