A 40-year-old female patient presented with headache, seizures, and altered consciousness. She was diagnosed with venous congestive encephalopathy secondary to venous sinus thrombosis based on MRI findings. The MRI showed dilation and enhancement of the dural sinuses and cortical veins, subcortical abnormalities, and a thrombosed superior sagittal sinus. The case publication was edited by Professor Yasser Metwally and provides MRI images illustrating the findings.

1. Short case publication... version 1.4 | Edited by professor Yasser Metwally | January 2008
Short case
Edited by
Professor Yasser Metwally
Professor of neurology
Ain Shams university school of medicine
Cairo, Egypt
Visit my web site at:
http://yassermetwally.com
A 40 years old female patient presented with headache, fits, and disturbed level of
consciousness..
DIAGNOSIS: VENOUS CONGESTIVE ENCEPHALOPATHY SECONDARY TO VENOUS SINUS THROMBOSIS

2. Figure 1. Cerebral congestive encephalopathy. MRI T1 postcontrast study showing dural sinus and cortical
venous dilations and enhancement due to widespread dural sinus & cerebral venous thrombosis. The enhanced
cortical and transcerebral veins are seen forming the hyperdense cord signs which are seen radiating to the
dilated and thrombosed dural sinuses. Also notice parenchymal subcortical hypointensities and patchy, irregular
and linear enhancement with mass effect which could be due to edema, infarction or ischemia, forming what is
called cerebral congestive encephalopathy.
Figure 2. Venous congestive encephalopathy due to venous hypertension secondary to venous thrombosis. MRI
T2 images showing subcortical white matter hyperintensities with mass effect, mixed with linear and patchy
hypointensity and signal void structures. Changes are due to edema, petechial hemorrhages and dilated veins.

3. Figure 3. Cerebral congestive encephalopathy. MRI T1 postcontrast study showing dural sinus and cortical
venous dilations and enhancement due to widespread dural sinus & cerebral venous thrombosis. The enhanced
cortical and transcerebral veins are seen forming the hyperdense cord signs which are seen radiating to the
dilated and thrombosed dural sinuses. Also notice parenchymal subcortical hypointensities and patchy, irregular
and linear enhancement with mass effect which could be due to edema, infarction or ischemia, forming what is
called cerebral congestive encephalopathy.
Figure 4. MRI T1 postcontrast study showing dural sinus and cortical venous dilations and enhancement due
to widespread dural sinus & cerebral venous thrombosis. The enhanced cortical and transcerebral veins are
seen forming the hyperdense cord signs which are seen radiating to the dilated and thrombosed dural sinuses.
Also notice parenchymal subcortical hypointensities and patchy, irregular and linear enhancement which
could be due to edema, infarction or ischemia, forming what is called cerebral congestive encephalopathy.

4. Figure 5. MRI T1 postcontrast study showing enhancement and dilation of the thrombosed superior
sagittal sinus with central hypointense filling defects which could be due to the intraluminal thrombi.
Dilated enhanced cortical veins are seen pouring in the thrombosed sinus, subcortical parenchymal
hypointensity could be due to edema or infarction
Addendum
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References
1. Metwally, MYM: Textbook of neurimaging, A CD-ROM publication, (Metwally, MYM editor) WEB-CD agency
for electronic publishing, version 9.1a January 2008