Convexal subarachnoid hemorrhage secondary to superior sagittal sinus thrombosis
Presentation
One week postpartum after uncomplicated pregnancy. Progressing left-sided upper latent monoparesis with persistent headache.
Patient Data
Initial study
Right-sided isolated subarachnoid hemorrhage along the central sulcus. Preserved, discreetly accentuated grey-white matter differentiation. No signs of trauma. CTA demonstrates extensive filling defect, confirming superior sagittal sinus thrombosis (SSST). No aneurysmal dilatation or arteriovenous malformation.
Case Discussion
Without a typical empty delta sign, besides subtle, inconclusive signs of vasogenic edema, secondary to venous hypertension (cf. cytotoxic edema in arterial infarct), a confined convexal subarachnoid hemorrhage (cSAH) indicates a possible superior sagittal sinus thrombosis. Hemorrhage could also be parenchymal - typically cortical or paramedian - and would not be confined to an arterial vascular territory.
Cerebral venous sinus thrombosis (CVST), an uncommon complication during puerperium, should be considered in the differential diagnosis in case of neurological complaints during pregnancy or the postpartum period. Early diagnosis and prompt treatment is vital for long-term recovery due to potential reversibility of venous infarct with anticoagulation.
Unable to process the form. Check for errors and try again.