Presentation
Unwell with headache, vomiting and photophobia? meningitis or subarachnoid hemorrhage
Patient Data
High density within the superior and inferior sagittal sinus, straight sinus and both transverse sinuses, in keeping with extensive dural venous sinus thrombosis. Small focus of acute intraparenchymal hemorrhage in the left superior temporal gyrus white matter. The grey-white matter differentiation is well preserved with no definite evidence of ischemic changes.
No evidence of hydrocephalus, mass effect or midline shift.
The optic nerve sheaths appear distended in keeping with raised intracranial pressure.
Extensive dural venous sinus thrombosis is confirmed involving the superior and inferior sagittal sinus, straight sinus and both transverse sinuses, as well as the left basal vein of Rosenthal.
Small focus of hemorrhage in the left superior temporal gyrus as shown on CT. No other sites of parenchymal hemorrhage nor evidence of acute infarct.
Dilatation of the optic nerve sheaths. There is flattening of the insertion of the optic nerve into the globes bilaterally in keeping with papilledema.
Case Discussion
- Macrovascular lesions, such as venous thrombosis, underlie 10-15% of spontaneous intracerebral hemorrhage.
- Early identification of such abnormalities is important to allow appropriate treatment.
- Specific features on non contrast CT of an underlying macrovascular lesion include hyperdense dural venous sinuses and cerebral veins.
- Dural venous sinus thrombosis should be considered in patients presenting with clinical features of raised intracranial pressure