Cortical subarachnoid hemorrhage secondary to cerebral venous infarction
Presentation
Acute headache with generalized tonic-clonic seizures.
Patient Data
Non-enhanced CT brain shows a bilateral frontoparietal hypodense area with hemorrhagic transformation and bilateral cortical subarachnoid hemorrhage.
CT angiography doesn't show aneurysms or arteriovenous malformations.
T2-weighted axial image shows heterogeneous hyperintense infarct of the bilateral frontoparietal, associated with prominent hypointense signal changes, representing acute hemorrhagic elements (deoxyhemoglobin).
MRV shows occlusion of the superior sagittal sinus, right transverse, right sigmoid, and straight sinus.
Case Discussion
Subarachnoid hemorrhage associated with cerebral venous thrombosis is uncommon.
Acute subarachnoid hemorrhage, when isolated, suggests the presence of a vascular lesion, such as a ruptured aneurysm, and CT venography is not generally considered in the diagnostic workup of subarachnoid hemorrhage.
This case, however, demonstrates subarachnoid hemorrhage in the setting of a parenchymal abnormality and venography should be performed. Similarly when subarachnoid hemorrhage is over the convexity, even in the absence of parenchymal abnormality, a venous thrombosis should be considered.
Although CT or MR angiograms can be used to diagnose CVT, also they are important for ruling out other potential causes of SAH, such as intracranial aneurysms, before starting anticoagulant therapy.
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