Cerebral venous thrombosis

Case contribution: Dr Radhiana Hassan

Clinical: 

  • A 40 years old female
  • Underlying connective tissue disease on medication
  • Presented with headache, worsening in a few days
  • No fever, no meningism and no symptom of increased intracranial pressure
  • No body weakness
MRI brain in axial planes
MRI brain in axial plane, post contrast
MRI brain in sagittal and coronal plane T1-post contrast

MRI findings:

  • Venous infarction with hemorrhagic component seen at both parieto-occipital region (white arrows).
  • Subacute blood clot seen within the ¬†superior sagittal sinus extending (red arrow) to confluent and right transverse sinus (images not shown)
  • Post contrast shows filling defect within the sinuses mentioned above (yellow arrows)
  • Abnormal generalised dural enhancement is also seen

Diagnosis: Cerebral venous thrombosis complicated by hemorrhagic venous infarction.

Discussion:

  • Cerebral venous thrombosis refers to thrombus formation in either the deep or superficial venous drainage of the brain.
  • It prevents normal drainage causes break of blood brain barried and leak of blood into the brain tissue
  • It is a rare condition and aetiology is multifactorial.
  • About 30-40% of patients presented with intracranial hemorrhage. Bilateral parenchymal hemorrhage with clinical evidence of hypercoagulable state should raised suspicion of this condition.
  • Isolated subarachnoid hemorrhage may also occur although rare incidence.
  • Non-contrast CT shows hyperdensity of a cortical vein or dural sinuses. Acutely thrombosed veins appear as homogenous hyperdensity that fills veins and sinuses. This sign is seen in about one third of patient
  • Post contrast CT may show fillind defect (delta sign, dense triangle sign). It may also shows enhancement of dural lining of the sinus.
  • An ischaemic infarction with hemorrhagic component may also be seen.
  • MRI show thrombus with variable signal depending on age of the thrombus.
Author: radhianahassan