MRV Head
Claim CME CreditPOINT OF CARE INFORMATION
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.
CME Advisory Committee Disclosure:
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.
CA0588-MRV Head
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CA0588-MRV Head
Case ReportExam
Prior Study
There is evidence of aggressive right otomastoiditis with sigmoid plate dehiscence (coalescent otomastoiditis) producing a small volume, epidural abscess, which partiall compresses the adjacent dural sinus.
Focal deformity of the sigmoid sinus is evident at the site of epidural abscess, however, the remaining lumen of the right sigmoid sinus and the internal jugular vein are patent.
Intraluminal thrombus is present in the torcular herophile, the left transverse/sigmoid sinuses, extending into the high cervical left IJ.
CT Perfusion
No CT perfusion is available
CTA of the Neck
Thrombosis of the high cervical left internal jugular vein with collateral drainage into the other left neck veins. The right IJ is patent.
No soft tissue abnormality is evident within the cervical soft tissues.
CTA of the Head
No CTA of the head was obtained
Post Contrast Head CT
There is some evidence luminal thrombus in the posterior superior sagittal sinus. There is no filling of the right transverse sinus. There is opacification over the left transverse sinus, but it is more consistent with filling the dural wall venous plexus; no luminal filling is evident in the distal left transverse sinus or sigmoid sinus.
There is no evidence of reduced CT density within the venocapillary pool in either the cerebrum or cerebellum.
There is evidence of both optic hydrops and early hydrocephalus related to venous hypertension caused by the dural sinus egress block. It is concievable that the hydrocephalus could be in part related to meningitis associated with the right coalsecent otomasoiditis.
Findings
Post contrast CT Venocapillary Analysis
This head MRV was obtained 4 days after the initial post contrast temporal bone CT, and there is evidence of sagittal sinus thrombosis as well as the torcula and the mesial segment of the left transverse sinus. There is a segment where part of the lateral transverse sinus opacifies, but it is followed by absent flow in the sigmoid sinus and left IJ.There are intermittent segments of varying size of the SSS; it is smaller in the frontal area, prominent in the parietal area, and partly opacified n the posterior SSS segment. There is persistent deformity in the right sigmoid sinus caused by the epidural abscess but the lumen is opacified. It is likely that what appears to be patent segments in all but the right transverse/sigmoid sinuses, are actually opacification of the collateralized dural wall. This explains the segmental appearance to all the dural sinuses except the right transverse/sigmoid sinuses.
There is evidence of re-routing of the cerebral cortical veins. There is evidence that the frontal and Trolard veins connect across the midline through through the vertex venous lacunae; there is also evidence of transcranial venous collaterals filling retrograde into scalp veins.
Additonally, there is prominence of the left lateral venous confluence, which drains into the expanded venous plexus in the dural sinus wall of the left transverse sinus. There is opacification of the emissary venous channels exiting from the left transverse sinus into cervical veins. Opacified emissary veins also arise from the frontal portion of the SSS. Note: emissary venous connections are important means of providing venous egress in cases of dural sinus CVT.
Impression
2. There is evidence of venous re-routing utilizing pial/dural anastomotic connections (the venous lacunae over the vertex, and the lateral tentorial confluence on the left) draining into the expanded dural wall venous plexus.
3. Persistent right sigmoid deformity remains because of the persistent small epidural abscess adjacent to the right sigmoid plate.
