Presentation
Pregnant patient with index presentation of confusion and psychosis. Normal CSF chemistry and cell count. Blood cultures negative.
Patient Data
Extensive dural venous sinus thrombosis involving the sagittal, transverse and sigmoid sinuses, straight sinus and vein of Galen with extension into the right internal jugular vein. Empty delta sign present.
Diffuse abnormal leptomeningeal enhancement.
Associated significant sulcal effacement compatible with generalised brain swelling.
The basal cisterns are attenuated.
There is inferior displacement of the cerebellar tonsils.
No space occupying lesions, haemorrhage or infarctions.
Midline structures are central.
No hydrocephalus.
Partial opacification of maxillary (R > L) and ethmoid sinuses.
Case Discussion
Dural venous sinus thrombosis is a subset of cerebral venous thrombosis, often coexisting with cortical or deep vein thrombosis, and presenting in similar fashions. There is a wide spectrum of predisposing causes including;
- Trauma, infection, inflammation
- Pregnancy, oral contraceptives
- Metabolic (dehydration, thyrotoxicosis, cirrhosis)
- Haematological (coagulopathy)
- Collagen-vascular disorders (APLA syndrome)
- Vasculitis (Behçet)
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