CEREBRAL VENOUS SINUS THROMBOSIS

SUMMARY

QUESTION
1. PRESENTATION: 33yr old lady with severe headache, fever & left sided weakness.
2. BACKGROUND: Delivered healthy child 1 week prior.
3. O/E: drowsy, B/L papilloedema, right 6th nerve palsy, mild right hemiparesis.
4. INX: non-contrast CTB showed no abnormalities.

ANSWER
Cerebral venous sinus thrombosis

EXPLANATION

- Non-contrast CT, when not associated with venous haemorrhage or infarction can show subtle findings, relying on hyperdensity of the sinus being identified .
- Thrombus can appear as a hyperdense vein or sinus for the first 7-14 days; this is an accurate sign when present.
- With contrast administration, especially with a CT venogram, a filling defect in a sinus is sought.
- Defect in the sagittal sinus is referred to as the 'empty delta sign'.
- CTV has a reported sensitivity of 95% compared to DSA as the gold standard.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].