Case #4

Case #2

• Occlusive/near occlusive dural venous sinus thrombosis extending from the distal superior sagittal sinus into the left transverse sinus, left sigmoid sinus, left jugular bulb, and proximal left internal jugular vein. Thrombus also slightly extends into the proximal right transverse sinus and involves multiple left temporal cortical veins including the vein of Labbé
• Small area of cortical and subcortical T2/FLAIR hyperintensity in the left middle temporal gyrus with faint cortical restricted diffusion
• No acute hemorrhage
• No significant mass effect or hydrocephalus
• No evidence of proximal intracranial arterial occlusion

• Venous sinus thrombosis

• Think about sinus thrombosis when you see patterns of ischemia atypical for thrombotic infarcts, including:
  1. Superior sagittal sinus thrombosis -> symmetric parasagittal regions
  2. Vein of Labbe -> temporal lobe
  3. Deep venous thrombosis (straight sinus, internal cerebral veins) -> bilateral thalami
• Venous thrombosis progresses to ischemia much slower than arterial thrombosis, generally somewhere on the range of several days to several weeks. If the thrombus is treated/removed, the area of related edema will often resolve without progressing to infarct
• Deep venous infarcts are more serious than dural venous infarcts, particularly due to potential resulting thalamic ischemia
• Just like arterial infarcts, be sure to mention any associated mass effect or hemorrhagic transformation

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