Straight sinus thrombosis (SST)

Case contributed by Safwat Mohammad Almoghazy
Diagnosis certain

Presentation

A female patient with a history of long term oral contraceptive pills (OCP) presented with severe headache and vomiting.

Patient Data

Age: 30 years
Gender: Female

Day 0 (On admission).

ct

On non-contrast CT; a short focal hyperdense area (the dense clot sign), seen at the posterior aspect of the joining of the tentorium cerebelli ( location of the straight sinus).  

On a contrast-enhanced CT (CECT); the straight sinus's posterior aspect could not be visualized with suspected filling defects, which shows hyperdensity in the plain study done about 6 hours ago. (non-enhancement of the thrombosed vein)

Otherwise normally enhanced superior sagittal, anterior aspect of straight and sigmoid sinuses bilaterally, denoting patency.

IMPRESSION:

Presence of the dense vein sign in plan CT and non-visualization of the posterior aspect of the straight sinus with suspected filling defects on CECT as described suggestive of focal straight sinus thrombosis versus arachnoid granulation for further assessment by MRI /MRV.

 

D1 day of 1st presentation

mri

Magnetic resonance imaging (MRI) confirms thrombosis of the straight sinus. Contrast-enhanced T1WI show a lack of flow and filling defect at straight sinus most likely thrombus.

 

2nd CT after 3 mth of Rx.

ct

Near totally resolved previously noted thrombus at straight sinus and no residual.

2nd MRI after treatment.

mri

In comparison with previous MRI study at ( day1 of admission )the current study;

Case Discussion

A 30-year-old female was admitted to the hospital with a severe headache and repeated vomiting. apart from a history of long term OCP, the patient's past medical history was unremarkable and there was no history of trauma. Otoscopy showed no abnormality of the ears. Routine blood chemistry revealed no abnormalities.

The patient underwent an emergency head multidetector computed tomography (MDCT) without intravenous contrast demonstrated no tumor or hemorrhage. The straight sinus was more hyperdense and this is a direct sign of thrombosis and a CECT, which confirmed the diagnosis.

CT imaging findings were compatible with thrombosis of the straight sinus thrombosis. Further evaluation of the findings was decided and magnetic resonance imaging (MRI) was performed. Contrast-enhanced T1WI confirmed a lack of flow.

After 3 months on anticoagulants treatment and follow up show totally resolved previously noted filling defect thrombus at straight sinus and complete canalization with return normal flow within and no residual filling defects currently.

It is important to recognize subtle imaging findings and indirect signs that may indicate the presence of thrombosis.

 

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