Age: 82
Sex: Male
Indication: Altered mental status
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Case #28
Findings
- Non-contrast CT:
- Large volume acute intraparenchymal hemorrhage in the high right frontal and parietal lobes with surrounding edema. There is also a small amount of subarachnoid hemorrhage layering in the sulci of the right cerebral convexity and a small amount of subdural hemorrhage along the falx and the right cerebellar tentorium. Associated 3 mm right to left midline shift and minimal subfalcine herniation
- Prominence of the temporal horn of the right lateral ventricle
- Venogram:
- Extensive thrombus within the superior sagittal sinus. The proximal left transverse sinus is diminutive with a questionable filling defect versus slow flow. Thrombosis of the right jugular bulb and right internal jugular vein
Diagnosis
- Dural sinus thrombosis with venous infarct and hemorrhagic transformation
Sample Report
Non-contrast CT:
Large volume acute intraparenchymal hemorrhage in the high right frontal and parietal lobes with surrounding edema. There is also a small amount of subarachnoid hemorrhage layering in the sulci of the right cerebral convexity and a small amount of subdural hemorrhage along the falx and the right cerebellar tentorium. Associated 3 mm right to left midline shift and minimal subfalcine herniation. No evidence of downward transtentorial or cerebellar tonsillar herniation.
Prominence of the temporal horn of the right lateral ventricle could represent early hydrocephalus. Recommend attention of followup studies with a low threshold to repeat imaging if the patient’s condition deteriorates.
Venogram:
Extensive thrombus within the superior sagittal sinus. The proximal left transverse sinus is diminutive with a questionable filling defect versus slow flow. Thrombosis of the right jugular bulb and right internal jugular vein.
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