IMAGE OF THE WEEK
CLINICAL HISTORY AND
35 year old male patient, a chronic alcoholic
presented to casualty with history of
headache 1 week, sudden onset,
associated with blurring of vision.
An episode of vomiting X 1 day.
O/E Patient was conscious oriented, looked
distressed and had R lateral rectus palsy (diplopia)
on CNS examination.
Urgent imaging (CT-Brain) was done,
FOLLOWING THE ABNORMAL CT
FINDINGS, MRI BRAIN WAS TAKEN
CT BRAIN AXIAL SECTIONS SHOWING
1. HYPERDENSITY IN THE RIGHT FRONTAL
2. HYPERDENSITY IN THE R TRANSVERSE
3. HYPODENSITY IN THE SUPERIOR SAGITTAL
SINUS (?EMPTY DELTA SIGN)
SUGGESTIVE OF ?PARENCHYMAL
HEMORRHAGE WITH CORTICAL VEIN
THROMBOSIS ?CALCIFIED GRANULOMA.
MRI BRAIN REPORT
MRI brain shows T1 hyperintense / non
suppressible T2 hyperintensity in the right
high parietal lobe. The lesion shows
peripheral blooming in T2 gradient sequence
suggestive of hemorrhage.
Absence of flow voids in mid sagittal and
transverse sinus in FLAIR images suggestive
of sinus thrombosis
T1 hyperintensity noted in superior sagittal
sinus and right transverse sinus suggestive of
MR venography confirms the evidence of
thrombosis in superior sagittal sinus and right
NUMBER- JOIN TO
CT FINDINGS IN CVT
Dense clot sign - Areas of thrombosis in sinuses
appearing as hyperdensities in unenhanced ct.
Cord sign - Dense cortical veins-uncommon direct
sign of cvt in unenhanced ct.
Venous infarction is the most non specific indirect
sign in unenhanced ct - presence of multiple
isolated lesions, subcortical involvement, more
than one arterial territory involved.
Empty delta sign - Filling defect with enhancing
rim on enhanced ct.
Contrast enhancement secondary to venous stasis
Diffuse brain swelling with edema and decreased
ventricular size might be present.
CT venogarhy allows direct visualisation of
MRI FINDINGS IN CVT
Can confirmatively tell presence of CVT.
Venous thrombus may be directly visualised.
Patent dural sinuses are seen as flow void
especially when the image is orthogonal to blood
Thrombus manifest as absence of flow void-best
seen in FLAIR and T2 weighted spin echo
T1 weighted - hyperintensity ; T2 weighted
gradient echo-exaggerated signal loss.
MR venography - shows direct visualisation of