Neuroimaging Cases 002

Cerebral venous sinus thrombosis

Latest instalment in our neuroimaging series. Images, text and cases collated by Brandon Friedman MD, Madison Watts MD, Faith Meyers MD and Steven Perry MD. First published on EMGuideWire.com and peer reviewed by Professor Michael Gibbs.

Cases reviewed

• Case 1: A 31-year-old female undergoing invitro fertiliation with hormone supplementation presented to the ED with 12 hours of headache, visual loss, and difficulty speaking.
• Case 2: A 32-year-old female with a recent Cesarian section complicated by chorioamnionitis, now on medroxyprogesterone acetate injections presented to the ED with 1 week of intermittent headaches, right upper extremity numbness, and syncope.
• Case 3: A 19-year-old female with recent admission for aseptic meningitis presented to the ED after a transient right sided hemiparesis and a seizure-like episode, now reporting a headache.
• Case 4: A 51-year-old female started on oral contraceptives for heavy vaginal bleeding presented to the ED for headaches, dizziness, and reported confusion by family.
• Case 5: A 23-year-old female with ulcerative colitis on Humira and prednisone presented to the ED for headache, transient inability to move her right arm, and diminished sensation in the right hand.

References

• Ropper AH, Klein JP. Cerebral Venous Thrombosis. N Engl J Med. 2021 Jul 1;385(1):59-64.
• Ulivi L, Squitieri M, Cohen H, Cowley P, Werring DJ. Cerebral venous thrombosis: a practical guide. Pract Neurol. 2020 Oct;20(5):356-367.
• Einhäupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, Masuhr F; European Federation of Neurological Societies. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010 Oct;17(10):1229-35.
• Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005 Apr 28;352(17):1791-8.
• Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004 Mar;35(3):664-70.
• Spadaro A, Scott KR, Koyfman A, Long B. Cerebral venous thrombosis: Diagnosis and management in the emergency department setting. Am J Emerg Med. 2021 Sep;47:24-29.
• Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, deVeber G, Ferro JM, Tsai FY; American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011 Apr;42(4):1158-92.
• Inman BL, Long B, Gottlieb M. What Is the Efficacy and Safety of Direct Oral Anticoagulants Compared With that of Vitamin K Antagonists in Patients With Cerebral Vein Thrombosis? Ann Emerg Med. 2022 Oct;80(4):329-331.

This neuroimaging interpretation series is proudly sponsored by the Emergency Medicine Residency Program at Carolinas Medical Center. The goal is to promote widespread mastery of CXR interpretation. There is no personal health information [PHI] within, and ages have been changed to protect patient confidentiality.