Superior sagittal sinus thrombosis
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Previously fit and well. Sudden onset headache. Please exclude subarachnoid hemorrhage.
CT on admission from ED
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Non contrast CT head shows high density in the superior sagittal sinus. No associated hemorrhage or parafalcine edema.
The CT venogram confirms a large filling defect throughout the superior sagittal sinus consistent with venous sinus thrombosis.
This diagnosis can be overlooked in the emergency setting when the suspected diagnosis is often subarachnoid hemorrhage. Acute thrombus can be difficult to identify on an enhanced study, particularly in the superior sagittal sinus on axial imaging. Use the coronal and sagittal MPRs to assess the venous sinuses.
The venous sinuses are an important review area and contrast enhanced venography is indicated to confirm the diagnosis.