Infarction due to SSS thrombosis

Case contribution: Dr Radhiana Hassan


  • A 67 years old man with sudden onset of altered sensorium
  • History of reduced oral intake and shortness of breath few days before
  • Patient had underlying lung carcinoma, opted for conservative treatment
  • History of left eye MALT lymphoma, completed radiotherapy
  • GCS on arrival at ED=E4V1M5

CT scan findings:

  • CT scan show ill-defined hypodensity at right frontal lobe (white arrow) which show no enhancement on post contrast image
  • Non-contrast reformatted sagittal image showed hyperdensity conforming to superior sagittal sinues (red arrows) seen. On post contrast images, filling defect (yellow arrows) are seen at the same region.

Diagnosis: Cerebral infarction caused by superior sagittal sinus thrombosis

Discussion (dural venous sinus thrombosis):

  • Location: superior sagittal>transverse >sigmoid>straight sinus
  • NCCT usually subtle findings include hyperdense clotted blood in the sinus, compression of lateral ventricles, infarction or edema, parenchymal hemorrhage and subdural collection
  • CECT: filling defect in the sinus, enlargement of thrombosed veins near obstruction, shaggy irregular contour of the veins, gyral enhancement in periphery of infarction in 30-40% of cases, intense tentorial enhancement due to collaterals and dense transcortical medullary veins
  • MRI can look for thrombus which show different signal intensity based on duration of thrombus, subcortical haemorrhagic infarctions, wall enhancement of thrombosed sinus, MRV show absence of flow
  • Angiogram: non-filling thrombosed sinus, filling of cortical veins, deep venous system  and cavernous sinus, parasagittal hemorrhages.
  • Prognosis: high mortality
  • Treatment: heparin, full recovery in 70% of cases

Progress of patient:

  • Patient admitted and treated for hypovolaemia and hyponatraemia
  • Had one episode of acute coronary symptoms while warded
  • Died 5 days after CT scan


Author: radhianahassan