Venous sinus thrombosis and haemorrhage

Case contributed by A.Prof Frank Gaillard

Presentation

Sudden onset of headache

Patient Data

Age: 40 years
Gender: Female

Intraparenchymal haemorrhage in the posterior left temporal lobe with surrounding subarachnoid blood and blood layering on the tentorium cerebelli. The left transverse sinus is hyperdense. Hypodense region surrounding the haemorrhage in keeping with oedema.

Mild effacement of the left ambient cistern. No midline shift. Grey-white matter differentiation is preserved with no evidence of acute ischaemia. Old left lacunar infarct. No calvarial fracture or suspicious bony abnormality seen. Imaged paranasal sinuses and mastoid air cells are clear.

Conclusion:

Left temporal lobe haemorrhage with surrounding oedema, in association with hyperdense left transverse sinus. The findings are most in keeping with a venous infarct secondary to venous sinus thrombosis.

CT

CT Venogram

Venogram reveals absence of opacification of the torcula, left transverse and sigmoid sinuses extending to the jugular bulb. The visualised upper left internal jugular vein contains contrast with central hypodensity consistent with thrombus. 

Conclusion:

Left transverse and sigmoid sinus thrombus extending into the left internal jugular vein. 

Case Discussion

A parenchymal haemorrhage, particularly in a younger patient, should trigger a careful scrutiny of relevant dural venous sinuses and cortical and deep veins for hyperdensity indicating thrombus, keeping in mind that acute thrombus only gradually becomes hyperdense. 

The location of this haemorrhage (inferior temporal lobe) is a classic location for a transverse / sigmoid sinus thrombosis, often secondary to mastoiditis (not present in this case). 

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Case information

rID: 32643
Case created: 7th Dec 2014
Last edited: 10th Mar 2016
Inclusion in quiz mode: Included

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