Case Images
Case Notes
History
29 year old female presenting acutely with dysarthria, apahsia, facial droop. Patient was in an automobile accident 3 weeks earlier. Patient is not on birth control meds.Exam
Prior Study
noneDicom
Findings
| Observation: Evidence of a Dural Sinus Thrombosis or Co-Morbid Cause for Thrombosis | Correct Answer | Your Answer |
|---|---|---|
|
There is evidence of acute thrombosis of any dural sinus or the torcular herophile. |
Yes | NA |
|
There is evidence of acute thrombosis of the jugular fossa segment of the sigmoid sinus (possible “jugular fossa syndrome”). |
Yes | NA |
|
There is evidence of acute thrombosis of either high cervical internal jugular veins. |
No | NA |
|
There is evidence of a straight sinus thrombosis. |
Yes | NA |
|
There is evidence of aggressive otomastoid sinus disease, which could lead to internal jugular vein or sigmoid or transverse sinus thrombosis. |
No | NA |
|
There is evidence of cavernous sinus thrombosis. |
No | NA |
|
There is evidence of aggressive sphenoid sinus or retropharyngeal infectious disease, which could lead to cavernous sinus thrombosis. |
No | NA |
|
There is evidence of dilatation of the orbital veins (optic hydrops). |
No | NA |
| Observation: Evidence of a Recognizable Cortical Vein Thrombosis or Co-Morbid Cause for Thrombosis | Correct Answer | Your Answer |
|---|---|---|
|
There is evidence of supratentorial cortical vein thrombosis or cytogenic edema corresponding to a recognizable cortical vein (i.e. a cerebral venous vector). |
Yes | NA |
|
There is evidence of infratentorial cortical vein thrombosis or cytogenic edema corresponding to a recognizable cortical vein (i.e. a posterior fossa venous vector). |
No | NA |
|
There is evidence of frontal or frontoethmoid sinusitis, which can cause frontal vein thrombophlebitis. |
No | NA |
|
There is evidence of deep central vein (ICV, septal vein, thalamostriate) or vein of Galen possibly including the straight sinus thrombosis. |
Yes | NA |
|
There is evidence of basal vein of Rosenthal thrombosis. |
Yes | NA |
|
There is evidence of invasive or allergic (AFS) nasopharyngeal fungal disease, which could lead to cavernous sinus thrombosis. |
No | NA |
|
There is evidence of post surgical vein sacrifice. |
No | NA |
|
There is evidence of focal mass effect (i.e. meningioma, depressed skull fracture, transcranial herniation) compressing either a dural sinus, or cortical vein(s), or both. |
No | NA |
| Observation: Evidence of Secondary Effects of Venous Hypertension | Correct Answer | Your Answer |
|---|---|---|
|
There is evidence of recent intracranial parenchymal (intra axial) hemorrhage in a venous egress zone. |
No | NA |
|
There is evidence of recent intracranial subarachnoid/cisternal hemorrhage. |
No | NA |
|
There is evidence of subpial prepontine venous hemorrhage. |
No | NA |
|
There is evidence of early hydrocephalus. |
Yes | NA |
|
There is evidence of pseudotumor cerebri. |
Yes | NA |
| Other | Correct Answer | Your Answer |
|---|---|---|
|
Other findings are present consistent with a disorder other than CVT. |
No | NA |
Impression
Expert Answer
There is evidence of dural sinus thrombosis in multiple sites, plus evidence of cortical vein thrombosis in the vertex veins bilaterally, and the right basal vein of Rosenthal, plus evidence of deep central vein thromboses. There is evidence of optic hydrops consistent with at least some degree of raised intracranial pressure associated with raised venous pressure caused by the dural sinus thromboses. There in focal enlargement of the right temporal horn, which could also be evidence of raised pressure caused edema related to the right vein of Rosenthal thrombosis.
Your Answer
Recommendations & Acuity
Recommendations
Expert Answer
Proceed with CVT imaging
Your Answer
Acuity
Expert Answer
Emergent: non-routine communication required immediately or within 30 minutes
