Dural sinus thrombosis complicating mastoiditis with subarachnoid haemorrhage and venous infarction

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Headache for 3 days followed by right sided weakness.

Patient Data

Age: 30 years
Gender: Male

Hyperdense left transverse sinus as well as the superior and inferior sagittal sinuses with mild distension. 

Left mastoiditis with T2 prolongation.

Subacute dural sinus thrombosis of the left sigmoid sinus as well as the superior transverse sinus with mild distension with loss of their signal void as well as slightly hyperintense T1 and hyperintense T2/FLAIR signal intensity.

Bilateral high frontoparietal sulcal FLAIR hyperinitensity is noted as well as distension of the cortical veins with left fronto-parietal area (most notably at the left post-central gyrus and to lesser extent the pre-central gyrus) of diffusion restriction and probable haemorrhage (seen on DWI and SWI). 

Right phthesis bulbi.

Loss of normal blood flowing signal within the left transverse and sigmoid sinuses as well as the superior and inferior sagittal sinuses. Patent average calibre of the right sigmoid and transverse sinuses. Patent average calibre of the straight sinus as well as the internal cerebral veins and great vein of Galen. No MRV evidence of arterio-venous malformation (AVM).

Case Discussion

Left mastoiditis that is complicated by subacute dural sinus thrombosis of the left sigmoid sinus as well as the superior transverse sinus with mild distension and loss of their signal void. Bilateral high frontoparietal sulcal FLAIR hyperinitensity consistent with subarachnoid haemorrhage as well as distension of the cortical veins with left fronto-parietal area (most notably at the left post-central gyrus and to lesser extent the pre-central gyrus) of diffusion restriction consistent with acute venous infarction.

 

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Case Information

rID: 49390
Case created: 22nd Nov 2016
Last edited: 16th Mar 2017
Inclusion in quiz mode: Included

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