Presentation
New onset left sided hemiparesis. Query stroke or migraine.
Patient Data
hyperattenuation of the torcula, right transverse and sigmoid sinuses through to the right internal jugular vein on non-IV contrast CT
linear filling defects of the torcula, right transverse and sigmoid sinuses through to the right internal jugular vein
further filling defect in the superior sagittal sinus at the vertex
right posterior fossa arachnoid cyst
venous sinus thrombosis involving the superior sagittal sinus, adjacent cortical veins, right transverse sinus and right sigmoid sinus
FLAIR hyperintensity and susceptibility artefact in the central sulcus and bilateral occipital/posterior temporal lobes, consistent with subarachnoid hemorrhage
no established infarct
right posterior fossa arachnoid cyst
Case Discussion
Findings in this case are consistent with dural venous sinus thrombosis, with a dense vein sign shown on initial non-IV contrast brain CT.
The patient in this case was treated with long-term anticoagulation and optimization of hormonal contraceptive (lower estrogen dose) to minimize future risk.
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