Case Images
Case Notes
History
30 year old female who is one week post partum and presents with severe headache and some nonspecific change in vision.Exam
Prior Study
CT headThere is thrombosis of the right vein of Trolard. There is hemorrhagic conversion of the thrombosed vein of Trolard producing local mass effects.There are small volume subarachnoid blood products evident within vertex sulci bilaterally and in both the suprasellar and prepontine cisterns.
CT Perfusion NO imaging available
CTV/MRV of the neck NO imaging available
MRV of the head
There is mesial segmental occlusion of the right vein of Trolard. Focal displacement of cortical veins in the right parietal vertex is related to the parenchymal hematoma associated with the vein of Trolard thrombosis.
Anomolous, hypoplastic frontal SSS segmental hypoplasia is present as an anatomic variant.
Delayed post contrast CT of the venocapillary pool: No imaging available
T1-w sequence: No imaging available
MR diffusion
Focal right vertex hemorrhage obscurs any evidence of MR diffusion positivity to confirm venous stroke.
Dicom
Findings
| MR T2 or FLAIR | Correct Answer | Your Answer |
|---|---|---|
|
There is positive T2-w/FLAIR in a recognizable dural sinus and possibly its' input venous confluences indicating dural sinus CVT. |
No | NA |
|
There is abnormal FLAIR (can be positive or negative signal) in a recognizable cortical or deep central vein egress zone indicating CVT. |
Yes | NA |
|
There is regional thickening of the dura (positive FLAIR) consistent with expanded venous plexus within the dural wall related to dural venous collateralization, or generalized dural thickening related to raised intracranial pressure. |
No | NA |
|
There is abnormal FLAIR signal in a site of positive MR diffusion venous infarct. |
No | NA |
|
There is hemorrhagic conversion on FLAIR or T2-w. |
Yes | NA |
|
There is positive sulcal FLAIR indicating protein leak or subacute SAH. |
Yes | NA |
|
There is positive parenchymal FLAIR indicating post CVT ischemic leukomalacia. |
No | NA |
|
There is evidence of sufficient brain swelling or hemorrhage to produce a brain shift and/or herniation. |
Yes | NA |
|
There is evidence of abnormal ventriculomegaly plus FLAIR evidence of transepenymal fluid, effacement of sulci, increased protein in sulci consistent with early hydrocephalus rather than atrophy. |
No | NA |
|
There is evidence of abnormal widespread dilated cortical veins (especially on T2-w) consistent with dural AVM with venous outlet obstruction. |
No | NA |
|
There is evidence of optic hydrops and/or edema in the retroglobal soft tissues. |
Yes | NA |
| Other | Correct Answer | Your Answer |
|---|---|---|
|
Other findings are present consistent with a disorder other than CVT. |
No | NA |
Impression
Expert Answer
All the above are true.
Your Answer
Recommendations & Acuity
Recommendations
Expert Answer
Proceed with additional CVT imaging
Your Answer
Acuity
Expert Answer
Emergent: non-routine communication required immediately or within 30 minutes
