Expand ("E")   Collapse

Age: 13

Sex: Female

Indication: Seizure

Save ("V")

Case #3


Findings

  • 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


Diagnosis

  • Venous sinus thrombosis

Sample Report

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. Associated small area of congestive edema in the left middle temporal gyrus with faint cortical restricted diffusion possibly representing early ischemic changes.

No acute hemorrhage.

No significant mass effect or hydrocephalus.

No evidence of proximal intracranial arterial occlusion.


Discussion

  • 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


Images

Nonopacification of the left sigmoid sinus and left jugular bulb (red arrows) in contrast to the normally opacified structures on the right (green arrows) on this postcontrast image. Small area of FLAIR signal hyperintensity in the left middle temporal gyrus (red arrow). Faint cortical diffusion signal hyperintensity (red arrow). Venous Sinuses. Approximations of venous vascular territories of the brain.



📣 Feedback?

⌨️  Keyboard Shortcuts ("K")

Call Preparation

Prepare for call efficiently with interactive cases, sample reports, and annotated images.

1,400+ cases  91.25 CME

Call Simulator

   Neuro CT

250 cases

  Neuro MRI

146 cases

   Peds Radiographs

372 cases

   MSK Radiographs

281 cases

   Chest CT

84 cases

   Chest Radiographs

97 cases

   KUB

43 cases

   Body CT

127 cases

   Ultrasound

75 cases

Call Simulator

• Shuffle cases from our courses to simulate the mix of a call shift.
• Submit your own report before reviewing the case write-up.

Neuro Fellowship

Develop deeper knowledge of neuro topics with clinical pearls, differentials, and in-depth discussions.

118 cases  11.8 CME

   Brain Tumors

105 cases

   Neurodegenerative

13 cases

Call Preparation

   Neuro CT

250 cases

   Neuro MRI

146 cases

   Peds Radiographs

372 cases

   MSK Radiographs

281 cases

   Ultrasound

75 cases

   Chest CT

84 cases

   Chest Radiographs

97 cases

   Body CT

127 cases

   KUB

43 cases

Neuro Fellowship

   Brain Tumors

105 cases

   Neurodegenerative

13 cases

Call Simulator

• Shuffle cases from our courses.
• Submit your own report.

CME

• Earn up to 91 CME.
• Claim your CME to receive a certificate.

Call Simulator

• Shuffle cases from our courses to simulate the mix of a call shift.
• Submit your own report before reviewing the case write-up.

CME

• Earn up to 91 CME by completing cases in our radiology courses.
• Claim your CME to receive a certificate.

On Call

Quick references created specifically to help while on call.

  Peds Normals by Age

Reference database of normal imaging from birth to age 16

   Incidental Findings

Summary of consensus guidelines for managing incidental CT findings

   Media Index

Index of select illustrations & videos from our courses

  Neuro CT Mimics

Visual reference for common mimics of pathology on CT

On Call

  Peds Normals by Age

Reference database of normal imaging from birth to age 16

   Incidental Findings

Summary of consensus guidelines for managing incidental CT findings

   Media Index

Index of select illustrations & videos from our courses

  Neuro CT Mimics

Visual reference for common mimics of pathology on CT

Anatomy

Labelled radiographs and CT/MRI series teaching anatomy with a level of detail appropriate for medical students and junior residents.

   Pelvis

Pelvic MRI anatomy

   Chest

Chest radiograph & CT anatomy

   Body

Abdominal CT anatomy

   Cardiac

Cardiac CT anatomy

   Brain

Brain & calvarial anatomy on CT/MRI

   Cranial Nerves

Cranial nerves on MRI

   Shoulder

Shoulder MRI anatomy

   Knee

Knee MRI anatomy

   Temporal Bone

Resident/fellow-level anatomy

Anatomy

   Pelvis

Pelvic MRI anatomy

   Chest

Chest radiograph & CT anatomy

   Body

Abdominal CT anatomy

   Cardiac

Cardiac CT anatomy

   Brain

Brain & calvarial anatomy on CT/MRI

   Cranial Nerves

Cranial nerves on MRI

   Shoulder

Shoulder MRI anatomy

   Knee

Knee MRI anatomy

   Temporal Bone

Resident/fellow-level anatomy

Neuro Courses

Includes our call preparation neuro courses (Neuro CT and Neuro MRI) and our neuro fellowship courses.

   Neuro CT

250 cases

  Neuro MRI

146 cases

   Brain Tumors

105 cases

   Neurodegenerative

13 cases

   Congenital Hearing Loss

Coming soon

Neuro Courses

   Neuro CT

250 cases

   Neuro MRI

146 cases

   Brain Tumors

105 cases

   Neurodegenerative

13 cases

  Congenital Hearing Loss

Coming soon

CME

• Claim your CME to receive a certificate.

Call Simulator

• Shuffle cases from our courses to simulate the mix of a call shift.
• Submit your own report before reviewing the case write-up.

CME

• Earn up to 91 CME by completing cases in our radiology courses.
• Claim your CME to receive a certificate.

   Neuro CT

250 cases

   Neuro MRI

146 cases

   Peds Radiographs

372 cases

   MSK Radiographs

281 cases

   Ultrasound

75 cases

   Chest CT

84 cases

   Chest Radiographs

97 cases

   Body CT

127 cases

   KUB

43 cases

Call Simulator

• Shuffle cases from our courses to simulate the mix of a call shift.
• Submit your own report before reviewing the case write-up.

CME

• Earn up to 91 CME by completing cases in our radiology courses.
• Claim your CME to receive a certificate.

⌨️ Keyboard Shortcuts

View shortcuts

Zoom/Pan

  Full screen

  Window/Level

  Expand/collapse

  Scroll

  Save the case

  Close case/tab

Previous Slice (PC)

Next Slice (PC)

SHIFT Previous Slice (MAC)

 SHIFT Next Slice (MAC)

 Toggle presets

 Previous series (if multiple)

 Next series (if multiple)

  Previous case (⌘ ◄ on a mac)

  Next case (⌘ ► on a mac)

Toggle dark mode