Superior sagittal sinus thrombosis with subarachnoid hemorrhage and venous infarction
Presentation
Severe headache for a few hours. History of Cesarian section since two weeks.
Patient Data
Evidence of subarachnoid hemorrhage 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.
MRI Brain + MRV
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 hemorrhage smearing the cortical sulci. Thrombosis and distension of the related cortical veins are 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 hemorrhage with evident left high posterior parietal hemorrhagic venous infarction. Hyperdense thrombosed superior sagittal sinus is still noted.
Case Discussion
Acute to subacute superior sagittal sinus thrombosis with bilateral fronto-parietal subarachnoid hemorrhage and left high posterior parietal acute infarction.
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