Cerebral venous hemorrhagic infarct from venous sinus thrombosis

Case contributed by Dr Ian Bickle

Presentation

Acute dense left hemiparesis. Subsequent partial seizure. 6 weeks pregnant. SOL?

Patient Data

Age: 35
Gender: Female

Moderate sized parenchymal hemorrhage with moderate surrounding low attenuation at the junction of the right frontoparietal lobes (watershed territory).  Minimal mass effect.

Separate smaller more subtle hemorrhage in the right frontal lobe.

Prominent dense cortical veins at the right vertex.

CTV

Slight progression in the right frontoparietal hemorrhage.

The low attenuation in the frontoparietal region has increase and a new focus has developed symmetrically in the left paramidline.

Small filling defect in the mid portion of the sagittal sinus highly suggestive of thrombosis.

Case Discussion

The key aspect of this case from the initial presentation scan is the odd location of the hemorrhage. This should be an alert to undertake further investigations.

This combined with a previously well young adult and potential risk factors for venous sinus thrombosis of pregnancy was a indicator of this being a venous hemorrhage.

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Case information

rID: 55433
Published: 6th Sep 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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