Dural venous sinus thrombosis

Case contributed by Dr Vander Mijnsbrugge Ward

Presentation

Worsening headache. Vomiting. Takes contraceptive.

Patient Data

Age: 25
Modality: CT

Dense aspect of the superior sagittal sinus, left transverse sinus and left sigmoid sinus, suggestive for extensive dural venous sinus thrombosis.

No complication such as cerebral/cortical oedema or venous haemorrhage.

Modality: MRI

Extensive venous sinus thrombosis extending from the superior sagittal sinus to the left transverse and sigmoid sinus, up to the proximal internal jugular vein. Note that the proximal part of the right transverse sinus also contains thrombus.

No thrombus in the straight sinus or other the other deep cerebral veins.

Modality: MRI

MRV shows a lack of flow in the superior sagital sinus, the left transverse and sigmoid sinus, up to the proximal internal jugular vein. No flow in the proxiam right tranverse sinus. 

Good venous flow in the inferior sagital sinus, straight sinus and internal cerebral veins.

Modality: MRI

Confirmation of the extensive dural venous sinus trombosis, as described above. 

No parenchymal haemorrhagic components suggestive for venous infarction are noted.

Note the trombosed superficial cortical vein (left side), not visible on the CT/other MR images.

Modality: MRI

The extensive trombus is seen as a hyperintensityon T1, indicating a subacute clot formation.

Case Discussion

Non-contrast CT can be difficult for detecting a venous sinus trombosis when it is not as extended as in the case. Thrombus can appear as a hyperdense vein or sinus for the first 7-14 days.
It is imported to look for possible complications such as venous haemorrhage or infarction.

On MRI, the combination of 3D T1WI, GRE and MRV images are very sensitive for detection of a dural venous sinus trombosis, as wel as for the complications (venous hypertension, oedema, and even haemorrhage).

 

PlayAdd to Share

Case Information

rID: 49002
Case created: 4th Nov 2016
Last edited: 5th Nov 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.