Presentation
Headache
Patient Data
Noncontrast CT: Extensive hyperdensity of the venous sinuses. Trace intraventricular blood in the left occipital horn.
Extensive filling defect in the dural venous sinuses.
There is extensive thrombus present in the superior sagittal sinus, straight sinus, transverse and sigmoid sinuses bilaterally. The sinuses are expanded with TI isointense, T2 isointense material with loss of the normal T2 flow voids in the dural venous sinuses. No definite regions of microhaemorrhages. A focus of susceptibility blooming artefact adjacent to the left lateral ventricle occipital horn shows layering and is likely intraventricular. There are multiple punctate and curvilinear regions of abnormal diffusion restriction affecting the left supratentorial brain. Affected areas include the left temporal lobe, left caudate head, left corona radiata and centrum semiovale.
Conclusion: Extensive dural venous sinus thrombosis. Multifocal small infarcts affecting the left supratentorial brain.
Case Discussion
This is a case of extensive dural venous sinus thrombosis. The key to this case is noticing the abnormal hyperdensity of the venous sinuses on the non-contrast CT and realising that it is NOT a contrast enhanced study. On the MRI, the loss of normal flow void in the superior sagittal sinus is a classical feature and an important check area on other studies. In this case, a non-contrast MRI was performed because the patient was pregnant.
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