Cortical vein and dural sinus injury, multiterritorial vascular insult
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This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
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Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CB1422-Cortical vein and dural sinus injury, multiterritorial vascular insult
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CB1422-Cortical vein and dural sinus injury, multiterritorial vascular insult
Case ReportHistory
Exam
Findings
MRA BRAIN AND NECK
The circle of Willis is complete. There are no filling defects within the major intracranial vessels of the head to explain the ischemic changes seen on prior MR brain.
Flow voids within the major vessels of the neck are normal. No high-grade stenosis, occlusion, or dissection of the major arteries of the neck.
MRV BRAIN
There is again biparietal and bitemporal scalp edema/hematoma formation.
Right panhemispheric subdural hemorrhage extending to the falx is again noted. There are likely epidural hemorrhages along the suture and skull fractures. There is hemorrhage along the tentorium. Multifocal areas of subarachnoid hemorrhage is again seen.
There is diffuse moderate to severe stenosis of the inferior aspect of the superior sagittal sinus likely due to mass effect from subdural and epidural collections and mass effect.
There is decreased visualization of the cortical veins in the frontal parietal convexities mainly on the right with areas of abrupt cut off of the cortical veins, concerning for cortical venous injury. There are also areas of small linear filling defects in the superior sagittal sinus, suggesting areas of nonocclusive thrombus.
Right transverse sinus sigmoid sinus and jugular vein is patent. The right sigmoid sinus filled appropriately.
Medial left transverse sinus is patent. However, there is abrupt cut off of the distal left transverse sinus with nonfilling of the left sigmoid sinus, concerning for occlusion. Left jugular bulb is also not defined.
Impression
2. Acute cerebral ischemia involving multiple vascular territories as described.
3. No evidence of arterial abnormality in the head or neck.
4. Evidence of multifocal superficial cortical venous and dural sinus injury. Abrupt cut off and nonfilling of the distal left transverse sinus as well as the left sigmoid sinus, concerning for occlusion. Diffuse narrowing of the superior sagittal sinus inferiorly, likely due to mass effect from the epidural/subdural hemorrhages as well as nonocclusive partial thrombus. Nonvisualization of the cortical venous structures particularly in the right frontoparietal convexity representing cortical venous injury.
5. Multiple areas of scalp and suboccipital soft tissue hematoma/edema and skull fractures.
