Thrombosis of the Superior Sagittal Sinus
A34-year-old, healthy, nonsmoking woman with a history of oral combination contraceptive pills had suffered from tension-type headache for 3 weeks. Neurological examination revealed marginal dysmetria of the left hand. Contrast-enhanced CT examination (Figure⇓, A) was at first interpreted as normal. However, sagittal T1-weighted MR images without contrast material demonstrated high signal intensity in the superior sagittal sinus (SSS), suggesting thrombosis (B, arrows). Phase-contrast MR angiography confirmed the diagnosis, displaying attenuated and scattered signal in the SSS (C, arrows). A review of the contrast-enhanced CT scans revealed a filling defect in the SSS, the “delta sign” (arrows), consistent with sinus thrombosis. In addition, a transaxial T2-weighted MR image showed a small venous infarction in the right frontoparietal region (D, asterisk), explaining the neurological signs. The patient made an uneventful recovery with anticoagulant therapy for 6 months. At the end of the treatment period, the thrombosis had disappeared from the SSS in repeated MR images, and blood tests showed no prethrombotic disorders.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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