Cortical venous thrombosis with subarachnoid hemorrhage

Case contributed by Dr Dayu Gai

Presentation

Four days of generalized headache.

Patient Data

Age: 40 years
Gender: Male

Non contrast CT brain

CT

Serpiginous hyperdensity overlying the left frontal cortical region along with more focal hyperdensity along the superior sagittal sinus, concerning for left frontal cortical venous thrombosis extending into the superior sagittal sinus. More posteriorly in the left frontal region, there is subtle subarachnoid hyperdensity in keeping with subarachnoid hemorrhage.  No other abnormality identified in the supra- or infratentorial brain, including no intraparenchymal hemorrhage and no definite infarct.

The patient was recalled for a cerebral venogram. This confirms filling defects within a left frontal superficial cortical branch, as well as multiple defects throughout the sagittal sinus.  The subarachnoid hemorrhage is again noted more posteriorly.  No dural venous sinus or cerebral venous filling defects identified.

Case Discussion

A case of left cortical venous and superior sagittal sinus venous thrombosis with subsequent subarachnoid hemorrhage. The patient does not demonstrate any other complications, which can include venous infarct or intraparenchymal hemorrhage.

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