Superior sagittal sinus thrombosis with persistent falcine sinus

Case contributed by Mohamed Saber

Presentation

Severe headache and disturbed level of consciousness.

Patient Data

Age: 35 years
Gender: Male

Large left parietal cortical-subcortical hemorrhage with an underlying patchy area of diffusion restriction, eliciting blooming on GRE, high signal on DWI and low signal on ADC, consistent with hemorrhagic infarction. Mild surrounding edema with localized mass effect.
Associated distension, signal alteration (intermediate T1 and low T2), and significant abnormal GRE blooming of the dorsal segment of the superior sagittal sinus and multiple superficial cortical veins represent venous sinus thrombosis.

Poorly enhancing dorsal segment of the superior sagittal sinus with intraluminal hypodense thrombus compromising its lumen, creating an empty delta sign, inferring superior sagittal sinus thrombosis. Surrounding dilated superficial cortical veins. Thrombus extension to several superficial cortical veins, mainly on the left.

Incidental persistent falcine sinus with atretic straight sinus.

Case Discussion

Here is a case of superior sagittal sinus thrombosis complicated by cerebral hemorrhagic infarction. An incidental recanalized falcine sinus is seen extending from the vein of Galen to the superior sagittal sinus.

Adults with a persistent falcine sinus usually have no other associated intracranial abnormalities.

The most prevalent cause of recanalization of the falcine sinus is tumors (most commonly meningioma) compressing nearby venous structures, followed by venous thrombosis (mainly of the superior sagittal and transverse sinuses).

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