Cerebral venous thrombosis: superficial & deep venous system- Case Report

Clinical details: 60 year old female with no previous comorbidities presented with recurrent generalised seizures followed by altered sensorium. On examination, she was stuporous, Fundus showed papilledema and plantar was bilateral extensor.  Case Report Submitted by Dr Rahul Rajeev DM Neurology (Std) , Dr Sumer Sethi, MD Radiology 

CT imaging shows bilateral thalamic and basal ganglia hypodensities with bleeding in the posterior inter-hemispheric fissure. Left cerebellar hypodensity also is noted.

MRI + MRV

MRI : T2 and FLAIR hyperintense lesions in b/l basal ganglia, thalamus, internal & external capsule and left cerebellum.T2 and FLAIR hyperintense lesions are also noticed in the left medial occipito-temporal gyrus.  The basal ganglia and cerebellar lesions are hypointense on T1 , whereas the internal and external capsule lesions are isointense . The thalamic lesions in T1 are hypointense with heterogenous hyperintensity bilaterally. Patchy areas of diffusion restriction noted in b/l thalamus, basal ganglia and left cerebellum. No contrast enhancement of the lesions. Areas of blooming can be appreciated on SWI.

MRV : shows filling defect in entire length of left transverse sinus, sigmoid sinus, straight sinus, jugular bulb and internal jugular vein, extending onto sinus confluence . Filling defect is also seen in internal cerebral vein and vein of galen.