Cerebral venous infarction due to transverse sinus thrombosis

Case contributed by Dr Craig Hacking

Presentation

Sudden onset headache.

Patient Data

Age: 40 - 45 years
Gender: Female

Intraparenchymal hemorrhage in the posterior left temporal lobe with surrounding subarachnoid blood and blood layering on the tentorium cerebelli.

Hypodense region surrounding the hemorrhage in keeping with edema. Mild effacement of the left ambient cistern. No midline shift.

The left transverse sinus is hyperdense.

Grey-white matter differentiation is preserved with no evidence of acute ischemia. Old left lacunar infarct.

Conclusion

  • Left temporal lobe hemorrhage with surrounding edema and a hyperdense left transverse sinus.  The findings are most in keeping with a hemorrhagic venous infarct secondary to venous sinus thrombosis.
  • Associated subarachnoid blood.
  • CT Venogram is recommended.

Absence of opacification of the torcula, left transverse and sigmoid sinuses extending to the jugular bulb comfiming thrombosis. The visualized upper left IJV contains contrast with central hypodensity consistent with partial thrombus. The remainder of the venous sinuses opacify normally.

Regular arch anatomy. The vertebral arteries are co-dominant. The circle of willis and vertebrobasilar system opacify normally. Tortuous course of the distal left cervical ICA. No evidence of aneurysm, vascular malformation, dissection or significant arterial stenosis.

The posterior left temporal intracranial hemorrhage is unchanged with surrounding edema.

Conclusion

  • Left transverse and sigmoid sinus thrombus extending into the left IJV. The straight sinus drains to the right TS, the deep veins are patent and normal, there is a narrow channel from the SSS connecting through the torcula to the right TS.
  • Whilst a dedicated venogram of the neck vessels has not been performed, the thrombus extends into the jugular bulb and IJV just below this is patent.

Case Discussion

Example of venous infarct with hemorrhage due to dural sinus thrombosis.

Practical points (from dural venous sinus thrombosis article)

  • infarction in a non-arterial location, especially when bilateral or hemorrhagic
  • cortical or peripheral hemorrhage, especially when heterogeneous and gyriform
  • cortical edema
  • direct signs of a thrombus (e.g. dense clot sign, cord sign, empty delta sign)
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Case information

rID: 34688
Published: 25th Aug 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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