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
Post contrast head CT for venocapillary pool analysis
Purpose
To identify any site of reduced CT density in any area of the venocapillary pool to confirm site of significant oligemia.
To determine if there is opacification of the dural sinuses indicating patency. Note: luminal thrombosis is only confirmed when the dural sinus is viewed in cross-section. Thus, nearly always need to apply multiplanar reformations. Also note, the sites of luminal thrombosis are often segmental in different sites within different sinuses. These segmental dural thrombosis are bridged by dural sinus wall and venous lacunae collaterals. Hence, the next purpose.
To identify evidence of opacification of the dural sinus wall plus lack of luminal opacification to dural wall collateralization. Dural wall collateral typically enlarges the overall size of the dural sinus.
To determine the state of venous egress (i.e. pattern of how the blood gets out of the head) has been altered, or even reversed in direction.
To identify pial venous collateral veins, which usually increase size, characteristic serpiginous appearance, and altered filling pattern (they drain toward unexpected major vein sites). Flow direction is often reversed (vein gets larger at its’s source rather than when it approaches a dural sinus.
To identify sites of intraluminal thrombus, which will correspond to the vein course.
Idenitfy sites of hemorrhagic conversion, which usually eminate from the junction of the vein thrombus with the pial venous collateral (corresponding to the site of venous reperfusion).
Purpose
To identify any site of reduced CT density in any area of the venocapillary pool to confirm site of significant oligemia.
To determine if there is opacification of the dural sinuses indicating patency. Note: luminal thrombosis is only confirmed when the dural sinus is viewed in cross-section. Thus, nearly always need to apply multiplanar reformations. Also note, the sites of luminal thrombosis are often segmental in different sites within different sinuses. These segmental dural thrombosis are bridged by dural sinus wall and venous lacunae collaterals. Hence, the next purpose.
To identify evidence of opacification of the dural sinus wall plus lack of luminal opacification to dural wall collateralization. Dural wall collateral typically enlarges the overall size of the dural sinus.
To determine the state of venous egress (i.e. pattern of how the blood gets out of the head) has been altered, or even reversed in direction.
To identify pial venous collateral veins, which usually increase size, characteristic serpiginous appearance, and altered filling pattern (they drain toward unexpected major vein sites). Flow direction is often reversed (vein gets larger at its’s source rather than when it approaches a dural sinus.
To identify sites of intraluminal thrombus, which will correspond to the vein course.
Idenitfy sites of hemorrhagic conversion, which usually eminate from the junction of the vein thrombus with the pial venous collateral (corresponding to the site of venous reperfusion).
Prior Study
Noncontrast head CTAcute 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
There is 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.