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Case210b

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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

CT Head
There is acute thrombus within the superior sagittal sinus, the torcular herophile, the straight sinus, and both transverse sinuses. There is partial thrombosis within the high cervical jugular veins. There is acute thrombus in the lateral surface cortical veins adjacent to the dural sinuses, and in the right basal vein of Rosenthal, and in the right ICV, and in the vein of Galen. There is focal vasogenic edema in the right dorsal thalamus with some local mass effect. There is early optic hydrops and right temporal ventriculomegaly consistent with early effects of CVT induced raised intracranial pressure.

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Section 1

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Case210b

Findings

Initial Evaluation (Technical Aspects)

​ There is artifact associated with patient motion.

​ There is artifact associated with poor cardiac output-low contrast between normal and abnormal tissue.

​There is artifact associated with problematic contrast injection.

Evidence of Altered Venous Collateral Egress Either Fast Flow into Collateral Routes, or Slower Flow from Venous Congestion

​There is faster blood flow in a recognizable venous collateral egress territory with shortened TTP, prolonged MTT and increased or normal CBV and CBF.This egress collateral will typically exit into unusual dural sinuses (i.e. sphenoparietal sinus, cavernous sinus, pharyngeal plexus, interior petrosal sinus, etc).

​There is slower blood flow with increased CBV in areas adjacent to the sites of CVT, which are consistent with venous congestion (expanded venocapillary pool) caused by downstream egress obstruction. This can be associated with elevated cerebral pressure.

​There is prolonged TTP (with dural wall collateralization) or absent TTP/CBV/CBF (thrombosis without dural wall collateralization) within one or more thrombosed dural sinuses.

Evidence of Thrombosed Major Cortical Vein(s)

​There is prolonged TTP  with variable (most often close to normal) CBV & CBF confined to a major supratentorial cortical (frontal ,Trolard , Labbe’, superior sylvian  complex) vein(s).

​There is prolonged TTP with variable (most often close to normal) CBV & CBF confined to a specific major infratentorial cortical (petrosal vein, cerebellar hemispheric, superior or inferior vermian) vein(s).

​There is shortened TTP with variable (most often close to normal) CBV & CBF confined to a specific major infratentorial cortical (petrosal vein, cerebellar hemispheric, superior or inferior vermian) vein(s).

​There is prolonged  TTP with variable (most often close to normal) CBV and CBF confined to the deep central veins (ICV, vein of Galen).

​ There is CT perfusion evidence of hemorrhagic transformation.

​ There is CT perfusion evidence of seizure related hyperemia, especially in the context of brain hemorrhage.

Evidence of Thrombosed Cavernous Sinus

​There is evidence of cavernous sinus thrombosis with reduced blood flow within the cavernous sinus and its efferent output veins. There may be congestion within its afferent input veins.

​There is increased CBV in the cavernous sinus consistent with re-routed venous collateralization through the superior sylvian vein/sphenoparietal sinus/ cavernous sinus/retropharyngeal pathway).

​There is thrombosis of the cavernous sinus related to nasopharyngeal or central skull base infection or infiltrative mass.

Other

​There are other findings are present consistent with a disorder other than CVT.