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
MR T1-w sequences pre contrast only
Purpose
Assess the noncontrast T1-w MR for hyperintense thrombus in one or more dural sinuses (i.e. the delta sign).
Assess the noncontrast T1-w MR for hyperintense thrombus in one or more pial or deep central veins.
Assess the noncontrast T1-w MR for blood products (SAH, hemorrhagic conversion).
Note: acute thrombus may be hyperintense on T1-w MR, just as it is hyperdense on CT, but it depends on the presence of met hemoglobin. Therefore,thrombi become hyperintense later than hyperdensity on CT. Hyperacute intraluminal thrombus on noncontrast T1 is more often isodense relative to brain but the isodense clot removes the expected flow void (actually a technical saturation effect).
Assess noncontrast T1 MR for venous congestion within the expanded medullary veins due to distal venous egress block.
Purpose
Assess the noncontrast T1-w MR for hyperintense thrombus in one or more dural sinuses (i.e. the delta sign).
Assess the noncontrast T1-w MR for hyperintense thrombus in one or more pial or deep central veins.
Assess the noncontrast T1-w MR for blood products (SAH, hemorrhagic conversion).
Note: acute thrombus may be hyperintense on T1-w MR, just as it is hyperdense on CT, but it depends on the presence of met hemoglobin. Therefore,thrombi become hyperintense later than hyperdensity on CT. Hyperacute intraluminal thrombus on noncontrast T1 is more often isodense relative to brain but the isodense clot removes the expected flow void (actually a technical saturation effect).
Assess noncontrast T1 MR for venous congestion within the expanded medullary veins due to distal venous egress block.
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.
Delayed post contrast CT
Dural sinus thrombosis is evident affecting the distal SSS, the straight sinus, the torcula, and both mesial segments transverse sinuses proximal to the lateral tentorial venous confluences. There is moderate venous congestion in the deep central venous system. The venous congestion accounts for the size effacement of the upper third ventricle. There is no evidence of venous stroke nor hemorrhagic conversion.