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Subarachnoid Hemorrhage as the Initial Presentation of Dural Sinus Thrombosis

Catherine Oppenheima, Valérie Domigob, Jean-Yves Gauvrita,c, Catherine Lamyb, Marie-Anne Mackowiak-Cordolianid, Jean-Pierre Pruvoc and Jean-François Médera

a Department of Neuroradiology Sainte-Anne Hospital, Paris V University
b Department of Neurology Sainte-Anne Hospital, Paris V University
c Department of Neuroradiology University Hospital of Lille, France
d Department of Vascular Neurology, University Hospital of Lille, France



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  		FIG 1. Case 1. A–B, FLAIR images (9800/152/2300/1) showing hyperintensities sparing the basal cisterns and involving the sulci of the right convexity, compatible with an acute subarachnoid hemorrhage.

C, T1-weighted spin echo image (480/9/1) revealing signal changes within the superior sagittal sinus (arrow).



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  		FIG 2. Case 2.

A, E, Plain CT scan showing a bihemispheric subarachnoid hemorrhage, predominating in the left insular sulci.

B, F, FLAIR images (9800/152/2300/1) showing hyperintensities within the subarachnoid spaces.

C, FLAIR images (9800/152/2300/1) showing absence of signal changes in the basal cisterns and revealing a hyperintensity within the left transverse sinus (arrow).

G, T2-weighted image (7000/86.3/2) in the frontal plane confirming the presence of a hypersignal within the left transverse and superior sagittal sinuses (arrows), raising the suspicion of sinus thrombosis.

D, H, Venous phase of the digitized subtracted angiogram (A–P views) of the left carotid (D) and the left vertebral (H) arteries confirming the occlusion of the left transverse and superior sagittal sinuses. The right transverse sinus is not seen medially but fills laterally from venous collaterals and drains into the right sigmoid sinus.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X