Presentation
Patient admitted with eye complaint - detached retina. 24 hour into admission complains of dizzy spell. 14 hours later - seizure.
Patient Data
Small focal parenchymal abnormality at the left parieto-occipital junction.
Dense enlarged left transverse sinus.
Air in the anterior aspect of the left globe in keeping with recent surgery.
Repeat scan 14 hours - initial scan believed to be normal.
Acute focal hemorrhage at the grey-white matter interface of the left parieto-occipital region.
Dense left transverse and sigmoid sinus ( although less than the first CT scan ).
Air in the anterior aspect of the left globe in keeping with recent surgery.
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Subacute hemorrhage in the left parieto-occipital junction ( non -arterial distribution ).
T1 hyperintense left sigmoid and transverse sinus, with corresponding complete occlusion on the MRV.
Air in the anterior aspect of the left globe in keeping with recent surgery.
Resolving hematoma in the left parieto-occiptal region.
The degree of low attenuation at this site suggests an established infarction.
The dense left sigmoid and transverse sinus is no longer evident.
Case Discussion
Cerebral venous sinus thrombosis can often present clinically in a very non-specific manner, and easily missed without a strong clinical suspicion.
This case demonstrates sequentially on cross sectional imaging the appearances of dural sinus thrombosis along with an associated hemorrhagic venous infarction and its maturation.
The thrombosis is evident as a hyperdense left transverse/sigmoid sinus - the cord sign.
The infarct and subsequent hemorrhage in a non-arterial distribution additionally alerts the viewer to the suspicion of a venous infarction.