Findings
Axial T2, FLAIR, T1, DWI MRI images reveal loss of normal flow void showing T1, T2 hyperintense signal, restricted diffusion in lumen of right transverse, sigmoid sinuses and jugular bulb with right mastoiditis and bilateral papilledema. Prominent perioptic CSF spaces and tortuous bilateral optic nerves also noted (not shown in images).
Diagnosis
Subacute dural venous sinus thrombosis with features of raised intracranial pressure.
Summary
Cerebral venous thrombosis (CVT) is difficult to diagnose clinically because patients can present with a wide spectrum of nonspecific manifestations, the most common of which are headache in 89%–91%, focal deficits in 52%–68%, and seizures in 39%–44% of patients. Predisposing factors include local causes (trauma, brain tumors, infections like otitis, mastoiditis, sinusitis, meningitis) and systemic causes (hormonal imbalance, surgery, hematologic disease, systemic infections, and dehydration). Usually, acute CVT (1–5 days) is isointense on T1-weighted MR images and hypointense on T2-weighted MR images (deoxyhemoglobin); subacute CVT (6–15 days) is hyperintense on both T1- and T2-weighted MR images (methemoglobin), and chronic CVT (>15 days) is isointense on T1-weighted images and isointense or hyperintense in T2-weighted MR images. However, the use of T2*-weighted gradient-recalled-echo and susceptibility weighted MRI sequences improves the detection of acute-phase CVT because the magnetic susceptibility of deoxyhemoglobin makes dural sinus CVT hypointense.
Further reads
Canedo-Antelo, M., Baleato-González, S., Mosqueira, A. J., Casas-Martínez, J., Oleaga, L., Vilanova, J. C., Luna-Alcalá, A., & García-Figueiras, R. (2019). Radiologic Clues to Cerebral Venous Thrombosis. Radiographics : a review publication of the Radiological Society of North America, Inc, 39(6), 1611–1628. https://doi.org/10.1148/rg.2019190015
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