Case Notes
History
56 year old male presented with acute onset right facial droop, right arm weakness, and both difficulty speaking and comprehending.Exam
CTV of the head
Prior Study
Noncontrast CT headFocal left retrosylvian vasogenic edema matching the vein of Labbe' venous egress territory. Whether there is cytogenic edema in this area representing venous stroke remains indeterminate. There is acute thrombus in multiple branches of the left vein of Labbe' without apparent concurrent left transverse sinus thrombosis.
There is no hemorrhagic conversion.
CT perfusion
There is a focal area of reduced brain perfusion in the left retrosylvian area corresponding to oligemia resulting from thrombosis of the left vein of Labbe' (evident on the noncontrast head CT). There is both collateral zone physiologic hyperemia in the collateral zone surrounding the retrosylvian oligemic area plus evidence of re-routing of venous egress into the left superior sylvian vein complex and left lateral tentorial venous confluence. This accounts for the increased blood volumn (increased CBV) in the cavernous sinus and left transverse sinus.
CTA neck including the major dural sinuses
The CTA of the neck was negative for venous thrombosis in the cervical area. The CTA of the neck included the head as well and demonstrated patent dural sinuses.