Presentation
Postpartum headache.
Patient Data
An intermediate to high signal is seen replacing the signal void of the posterior part of the superior sagittal sinus in T1, T2, and FLAIR images. There is a similar signal of a right parietal cortical vein (Trolard) and along the course of the right transverse sinus. The superior sagittal and right transverse sinuses are non-visualized in MRV and replaced by collaterals reflecting the occlusion of both sinuses. An ill-defined high signal in both T2 and FLAIR images is seen affecting the right parietal region, cortical and subcortical in distribution, suggesting cortical edema secondary to venous hypertension.
Hyperdensity is seen along the posterior part of the superior sagittal sinus and the right transverse sinus. There is associated cortical edema at the right parietal region (at the same site of the abnormal signal previously described in MRI). Note the small-sized hyperdense collaterals at the posterior falx adjacent to the superior sagittal sinus.
Case Discussion
Dural sinus thrombosis usually affects the superior sagittal sinus. It usually manifests as a severe headache or thunderclap. Pregnancy and puerperium are risk factors for the development of dural sinus thrombosis. Signs of dural sinus thrombosis include the dense cord sign in CT, loss of the signal void in MRI, and cortical edema.