Venous infarct due to superior sagittal sinus and superior cortical vein thrombosis
Presentation
Acute worsening headache on a background of migraines but this headache is atypical. Right arm weakness and paresthesia.
Patient Data
Hypodensity and loss of grey whate matter differentiation involving the posterior left frontal lobe. Hyperdense superior sagittal sinus and left superficial cortical veins including the left vein of Trolard. These findings are consistent with a venous sinus thrombosis and resultant cortical infarction with vasogenic edema. No evidence of hemorrhage.
CT venogram
Filling defect in the mid superior sagittal sinus extending into a superior cortical vein and the left vein of Trolard.
Cortical high T2 and low T1 signal in the left precentral gyrus and to a lesser extent the left postcentral gyrus with diffusion restriction and low ADC values. Subcortical cytotoxic edema. SWI blooming artifacts in the adjacent left superior cortical veins and the vein of Trolard as well as the superior sagittal sinus in keeping with venous thrombosis. Further focal blooming artifacts within the infarcted parenchyma in keeping with microhemorrhage.
Case Discussion
The patient was on the combined OCP which was ceased. Thrombophilia screen was negative. Sensory changes resolved and motor weakness improved (4/5) with heparin.
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