Cerebral venous infarcts secondary to superior sagittal sinus thrombosis
Presentation
Headache, day 1 post partum
Patient Data
Areas of gyral swelling with adjacent white matter vasogenic edema is noted involving bilateral frontal parenchyma. Areas of blooming noted within, represent areas of hemorrhage (also seen on CT). Restricted diffusion is noted involving mainly the cortex suggestive of cytotoxic edema. Post contrast images depict the empty delta sign on axial images as well as the filling defect within the superior sagittal sinus. Also noted is extension of the thrombus into the cortical veins on the coronal images. (MR venogram could not be performed due to patient motion )
Axial non contrast CT showing
Multifocal areas of ill-defined hypodensity are noted involving the bilateral frontal white matter, also showing focal hyperdensity within. Hyperdense superior sagittal sinus as well as cortical veins along the high frontal region.
Case Discussion
The most common predisposing factor for venous sinus thrombosis is hypercoagulability in the setting of a prothrombotic condition such as pregnancy/post partum status. In this given clinical background, with headache also being one of the most common presentations, dural venous sinus thrombosis is the top differential. Imaging also depicts the empty delta sign in the superior sagittal sinus. CT/MR venogram is definitive for diagnosis, however could not be performed in this case due to patient movement. Patient was managed as for dural venous sinus thrombosis and showed considerable clinical improvement.
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