Dural venous sinus thrombosis and intracranial hypertension

Case contributed by Andrew Dixon
Diagnosis certain


2 months of headache. Severe last 24 hours.

Patient Data

Age: 25 years
Gender: Female

Hyperdensity within the superior sagittal sinus and several cortical veins at the vertex. No obvious cerebral edema (venous infarct) or hemorrhage seen.  

CT venogram confirms the presence of superior sagittal sinus thrombosis with empty delta sign. It also demonstrates bilateral narrowing of the distal transverse sinuses without thrombosis of these vessels. Excess fluid is seen within the optic nerve sheathes bilaterally along with subtle bulging at the optic discs in keeping with raised intracranial pressure. 

MRI several months later reveals persistent thrombosis of the superior sagittal sinus and ongoing features of raised intracranial pressure including narrowing of the transverse sinuses, partially empty sella, vertical tortuosity of the optic nerves, dilatation of the optic nerve sheathes and bulging of the optic discs. 

Case Discussion

A case of superior sagittal sinus thrombosis complicated by raised intracranial pressure with all the typical MRI features of intracranial hypertension evident. Young adult women are the classic demographic for spontaneous dural venous sinus thrombosis. 

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