Case Notes
History
16 year old female presenting with a severe headache, nausea and vomiting. Patient had photophobia but had no focal complaints nor findings on exam. Patient was on birth control.Exam
Noncontrast CT head
Purpose
Identify all areas of chronic post ischemic (or post traumatic/postoperative) damage, including encephalomalacia, subcortical leukomalacia, ischemic demyelination, shrunken gyri/ulegyria, since they will exhibit reduced flow on the CTV & CT perfusion;
Assess for acute edema in one or more recognizable venous egress zones, especially those affecting the major veins in both the supratentorial and infratentorial regions;
Assess for hyperdense venous thrombosis in the high cervical internal jugular veins or intracranial dural sinuses.
Assess for hyperdense venous thrombosis in any of the cortical veins;
Assess for hyperdense perivenous (SAH, subpial or parenchymal) hemorrhage in any of the cortical vein egress zones;
Search for aggressive sinusitis/otomastoiditis/parapharyngeal infection as a cause for cavernous sinus, or sphenoparietal sinus thrombosis, or cortical vein thrombosis.
Assess for early hydrocephalus, which can accompany widespread dural sinus thrombosis.
Purpose
Identify all areas of chronic post ischemic (or post traumatic/postoperative) damage, including encephalomalacia, subcortical leukomalacia, ischemic demyelination, shrunken gyri/ulegyria, since they will exhibit reduced flow on the CTV & CT perfusion;
Assess for acute edema in one or more recognizable venous egress zones, especially those affecting the major veins in both the supratentorial and infratentorial regions;
Assess for hyperdense venous thrombosis in the high cervical internal jugular veins or intracranial dural sinuses.
Assess for hyperdense venous thrombosis in any of the cortical veins;
Assess for hyperdense perivenous (SAH, subpial or parenchymal) hemorrhage in any of the cortical vein egress zones;
Search for aggressive sinusitis/otomastoiditis/parapharyngeal infection as a cause for cavernous sinus, or sphenoparietal sinus thrombosis, or cortical vein thrombosis.
Assess for early hydrocephalus, which can accompany widespread dural sinus thrombosis.