Superior sagittal sinus thrombosis

Case contributed by Dr Ian Craven

Presentation

Previously fit and well. Sudden onset headache. Please exclude subarachnoid hemorrhage.

Patient Data

Age: 40 years
Gender: Female

CT on admission from ED

CT

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.

Case Discussion

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.

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