MR T1-W Sequences
CA0608-MR T1-W Sequences
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CA0608-MR T1-W Sequences
Case ReportExam
Prior Study
Acute thrombosis is evident within the posterior (parietal/occipital) segments of the superior sagittal sinus extending into the torcular herophile and the straight sinus. There is no apparent cortical or deep central vein CVT.
CT perfusion: No CT perfusion is available
CTV of the neck: No CTV neck is available
CTV of the head
Evidence of partial recanalization of dural sinus thromboses, which include the parietal-occipital segments of the SSS, the torcular herophile, the initial segment of the transverse sinuses, and the straight sinus. Multiple effective routes of collateral venous egress are present, as listed above. There is also some antegrade venous blood flow after partial recanalization.
Delayed post contrast CT Dural sinus thrombosis is evident affecting the distal SSS, the straight sinus, the torcula, and both mesial segments transverse sinuses proximal to the lateral tentorial venous confluences.
There is moderate venous congestion in the deep central venous system. The venous congestion accounts for the size effacement of the upper third ventricle.
There is no evidence of venous stroke nor hemorrhagic conversion.
Findings
MR T1-W Sequence
There is absence of the expected flow void plus the presence of isodense tissue density in the distal SSS, straight sinus, torcula and initial transverse sinus segments on the noncontrast T1-w sequence consistent in intraluminal thrombus. Isointense thrombus that the thrombus is recent (before clot changes into met-hemoglobin state). The cross-sectional size of the distal SSS is enlarged, which is consistent with intraluminal thrombus plus dilated mural wall collateral. Note: isointense thrombus can easily be overlooked, and if there is functional collateral the brain will appear normal as well.
There is prominence of the deep medullary veins within the caudate nuclei and deep white matter. Although subtle the is more than expected. There is also effacement of the upper third ventricle. These finding are indicative of venous congestion in the deep venous system bilaterally. Similar findings were evident on the head CTV.
Ventricular size is within normal limits.
Impression
There is evidence of deep central venous congestion now affecting the deep medullary veins indicating at least moderate venous congestion.
There is no hemorrhagic conversion nor acute hydrocephalus nor clear evidence of optic hydrops.
