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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 Dilantin therapy.Exam
CTA of the neck
Purpose
Assess for internal jugular vein or sigmoid sinus thrombosis.
Assess for aggressive infections or invasive tumor in the nasopharynx and skull base.
Assess for exaggerated volume of blood in the retropharyngeal venous plexus, or in the inferior petrosal sinuses, or in the high cervical (suboccipital veins; all are potential collateral pathways in CVT.
Assess for cavernous sinus thrombosis.
Purpose
Assess for internal jugular vein or sigmoid sinus thrombosis.
Assess for aggressive infections or invasive tumor in the nasopharynx and skull base.
Assess for exaggerated volume of blood in the retropharyngeal venous plexus, or in the inferior petrosal sinuses, or in the high cervical (suboccipital veins; all are potential collateral pathways in CVT.
Assess for cavernous sinus thrombosis.
Prior Study
CT headAcute to subacute thrombosis of multiple dural sinuses is evident including the transverse sinuses on both sides, and the straight sinus.
Acute venous thrombosis is evident in both of the internal cerebral veins (ICV), the vein of Galen and the right basal vein of Rosenthal. There is edema in the dorsal right thalamus, but whether this is vasogenic edema or cytogenic edema (venous stroke) is indeterminate. There is also reduced CT density wihtin the superior vermis, but whether this is from prior radiation therapy (with leukomalacia) or whether it is related to retrograde propagation of clot from the vein of Galen into the superior vermian vein complex is indeterminate.
CT perfusion
There is deep central vein thrombosis producing venous congestion in the the subependymal venous system (i.e. caudate, thalamostriate, and deep medullary parenchymal vein), greater on the right than the left.
Thrombosis of the straight sinus is evident on the CTA, which is included with the CT perfusion data set, but there is no CT perfusion evidence of collateral flow in the dural sinus wall.
