Elderly patient with dural sinus thrombosis leading to abnormal medullary veins and cerebral venous infarctions

Abstract

We present a patient affected by a rapid neurological decline that was connected to subacute partial thrombosis of the straight sinus and associated with dilated superficial and deep medullary veins. An MRI scan confirmed signal alterations compatible with vascular disease and partial thrombosis of the straight sinus associated with dilated superficial and deep medullary veins of the cerebral white matter. Later, another MRI scan showed a replacement of the extensive white matter signal abnormalities, on FSE T2 and FLAIR sequences, by chronic vascular lesions.

Keywords: CT, computed tomography; MRI, magnetic resonance imaging.

Figure 1

75-year-old male with dural sinus thrombosis. Axial FSE T2 at the level of lateral ventricles shows diffuse hyperintensity signal of bilateral white matter of the frontal and parietal lobes. Some hyperintese areas near the middle cell and occipital horn of the left lateral ventricles are linked to vascular edema.

Figure 2

75-year-old male with dural sinus thrombosis. Axial FSE T2 shows diffuse signal hyperintensity of supraventricolar and subcortical white matter. These are associated with many small and medium hyperintense areas compatible with vascular infarctions.

Figure 3

75-year-old male with dural sinus thrombosis. Coronal FLAIR shows hyperintense signal of periventricular white matter, both in the frontal lobes and the right temporal lobe.

Figure 4

75-year-old male with dural sinus thrombosis. Axial DWI (1000b) shows hyperintense areas, especially on the left frontal white matter, which are linked to acute vascular lesions.

Figure 5

75-year-old male with dural sinus thrombosis. 3D-MIP (reformatted by 2D-TOF) sequence confirms venous flow reduction of the straight sinus near torcular of Herofilo (arrowheads); a flow reduction is also present at the level of the sagittal superior sinus, near the venous sinus confluence (arrows).

Figure 6

75-year-old male with dural sinus thrombosis. Axial SE T1 contrast enhancement shows multiple vessels with an oblique course between the wall of lateral ventricles and the subcortical white matter. Note particularly a vessel that surrounds the right frontal horn. A small enhancement area at the level of insular cortex represents minor telangiectasia.

Figure 7

75-year-old male with dural sinus thrombosis. Axial SE T1 contrast enhancement shows “threadlike” aspect of straight sinus (arrow); this is a direct sign of cerebral sinus thrombosis.

Figure 8

75-year-old male with dural sinus thrombosis. Axial FSE T2 obtained after 6 months shows a bilateral increase of fronto-parietal white matter signal alterations, with some chronic lacunar infarcts.

Figure 9

75-year-old male with dural sinus thrombosis. Axial FLAIR obtained after 6 months demonstrates a reduction of white matter signal alterations, with some chronic lacunar infarcts on the left frontal lobe.

Figure 10

75-year-old male with dural sinus thrombosis. Axial DWI (1000b) obtained after 6 months shows the sequelae of vascular injuries (arrowhead).

Figure 11

75-year-old male with dural sinus thrombosis. Coronal 2D-TOF slice obtained after 6 months shows the “threadlike” aspect of straight sinus with minimum residual flow (arrows).

Figure 12

75-year-old male with dural sinus thrombosis. 3D-MIP (reformatted by 2D-TOF) sequence obtained after 6 months does not show changes at the level of straight sinus (arrowheads); the superior sagittal sinus is now slightly more viewable (short arrow,) but there is still absence of flow near the confluence of the sinuses (long arrow).