Superior sagittal sinus thrombosis with subarachnoid haemorrhage and venous infarction

Case contributed by Dr Mohammad A. ElBeialy

Presentation

Severe headache since a few hours. History of Caeserian section since two weeks.

Patient Data

Age: 35
Gender: Female

Evidence of subarachnoid haemorrhage is seen smearing the cortical sulci of the posterior high fronto-parietal extra-axial CSF spaces.  

The superior sagittal sinus appears slightly distended and relatively hyperdense.  

Normal appearance of the ventricles with no midline shift or deformity. 

No masses or definite parenchymal areas of abnormal attenuation values seen. 

No gross posterior fossa abnormality. 

The superior sagittal sinus (SSS) appears significantly attenuated with thrombosis of its superior portion demonstrating intermediate T2 and FLAIR signal intensity. MR venography confirmed thrombosis of the SSS with lost signal.

Evidence of high posterior parietal and frontal subarachnoid haemorrhage smearing the cortical sulci. Thrombosis and distension of the related cortical veins is noted as well.   

Left high posterior parietal acute infarction with high diffusion weighted image (DWI) and low ADC signal.   

Normal ventricular system. 

Normal sellar and parasellar region.  

Normal posterior fossa.

Normal MR angiography of the cerebral arteries.   

Follow-up CT brain showed bilateral high posterior fronto-parietal subarachnoid haemorrhage with evident left high posterior parietal haemorrhagic venous infarction. Hyperdense thrombosed superior sagittal sinus is still noted. 

Case Discussion

Acute to subacute superior sagittal sinus thrombosis with bilateral fronto-parietal subarachnoid haemorrhage and left high posterior parietal acute infarction.  

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Case information

rID: 38432
Case created: 19th Jul 2015
Last edited: 16th Dec 2015
Inclusion in quiz mode: Included

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