Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 14, 2009
Thrombosis of the Superior Sagittal, Left Transverse and Left Sigmoid Sinuses
- Uncommon disorder effecting 2-7 cases per million in general population
- High risk groups include: hypercoagulable states from malignancy, peripartum state, protein C and S deficiencies, severe vomiting and dehydration.
- Non-contrast CT shows hyper-attenuating thrombus in occluded venous sinus(es), in 25% of patients.
- Contrast enhanced CT shows empty-delta sign from occluding thrombus surrounded by contrast in adjacent dural collaterals or channels.
- 2D/3D TOF MR venography is used more commonly than contrast-enhanced MRV, but CT venography is equivalent for detecting cerebral venous thrombosis.
- Cerebral parenchymal abnormalities can range from edema to infarction and are best seen with MR than CT; DWI imaging excellent for venous occlusion related ischemia (can be reversible once occlusion resolves)