Case Notes
History
54 year old male with history of epilepsy who presented with a 2 week history of progressive loss of coordination and balance. On admission the patient was aphasic but without focal findings. Patient is on long term DilantinExam
Noncontrast head CT
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.
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.