Dural venous sinus thrombosis and hemorrhage

Case contributed by Assoc Prof Frank Gaillard

Presentation

Two days of increasing headaches, now right sided weakness.

Patient Data

Age: 35 years
Gender: Female

This non-contrast CT scan of the brain demonstrates hyperdense superior sagittal sinus, straight sinus, vein of Galen, transverse sinus on the left and a number of cortical veins. In addition a region of low density with foci of hemorrhage is noted in the partial lobe on the right. 

Selected axial, coronal and sagittal images from a CT venogram confirms extensive venous thrombosis as demonstrated on the non-contrast CT. 

Thrombosed hyperdense superior sagittal sinus (SSS), straight sinus (SS), vein of Galen (VOG), transverse sinus (TS) on the left and a number of cortical veins (CV). In addition the inferior sagittal sinus (ISS) is not visualized on CT venogram and is presumably also thrombosed (or hypoplastic). A region of low density with foci of hemorrhage (yellow dotted line) is noted in the partial lobe on the right consistent with a venous infarct. 

Case Discussion

This young woman spontaneously developed extensive dural venous sinus thrombosis with right sided hemorrhage. The only risk factor identified was the oral contraceptive pill. 

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