What is the diagnosis?
This is a case of cerebral venous sinus thrombosis. There is a large clot around the confluence of sinuses and into the left collecting system (see next page for annotated images).
What other signs can be seen on scans in venous sinus thrombosis?
Important complications to recognise include signs of raised intracranial pressure, and venous haemorrhage which occur due to vessels rupturing near the clot. Luckily this patient did not have either of these.
What treatment is recommended?
Anti-coagulation is the mainstay of treatment for 3-6 months depending on risk factors. This is usually done with warfarin, however during pregnancy and breastfeeding, consideration for other treatments is needed due to the risk to the child. Follow up with neurology and ophthalmology is recommended.
Extensive venous sinus thrombosis within the distal superior sagittal sinus, straight sinus, confluence of sinuses, left sigmoid sinus and left proximal internal jugular vein.
Right transverse and sigmoid sinus spared.
Remainder of non-contrast imaging shows no abnormalities - in particular no mass lesion, infarct, haemorrhage, extra-axial collection or ventricular changes.