Presentation
Repeated attacks of vomiting and a decreased conscious level.
Patient Data
Bilateral thalamic hypodensity more at the right side with increased calibre and attenuation of deep cerebral veins and vein of Galen.
No intracranial haemorrhage.
CT venography shows lack of post-contrast opacification of the deep cerebral veins, vein of Galen, straight, right transverse and sigmoid sinuses suggestive of venous thrombosis.
Normal post contrast opacification of the superior sagittal, left transverse and sigmoid sinuses as well as internal jugular veins bilaterally.
Markedly increased hypodensity of brain white matter and basal ganglia associated with effacement of cortical sulci and relative sulcal hyperdensities (pseudosubarachnoid haemorrhage sign), findings represent advanced cerebral oedema.
Case Discussion
The patient presented with repeated vomiting and decreased conscious level, CT brain was asked to exclude central cause and CT venography was arranged immediately to confirm the diagnosis and determine the extent of the disease.
There was progressive deterioration of the conscious level, follow-up CT after about 24 hours revealed a progression of findings. The patient died 2 days later.
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