Case 7 - Superior Sagittal Sinus Thrombosis: CT, CTV

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAM: CT perfusion stroke protocol with and without IV contrast; CT head with and without IV contrast; CT neck with and without IV contrast only; CT head without contrast protocol

INDICATION: Witnessed seizure. Acute onset headache, left-sided weakness.

TECHNIQUE: CT angiography of the head and neck with intravenous contrast. CT perfusion stroke protocol with and without IV contrast and CT head without contrast stroke protocol. Multiplanar reformats were performed. Maximal intensity projection renderings were created.

COMPARISON: CT head/brain without contrast dated 10/23/2020

FINDINGS:

CT Head without contrast stroke protocol:

No acute intracranial hemorrhage or extra-axial fluid collection. No mass effect or midline shift. Preserved gray-white matter differentiation. Ventricles are symmetric and normal for age. Patent basal cisterns.

Normal orbits. Visualized paranasal sinuses and mastoid air cells are clear. No acute fracture or soft tissue abnormality.

CT perfusion:

Technically inadequate study. No gross abnormalities are seen.

CTA HEAD:

No aneurysm, high-grade stenosis, or dissection.

Intracranial ICAs: Patent

MCAs: Patent

ACAs: Patent

A-Comm: Patent

P-Comms: Patent

Vertebral arteries: V4 segments are patent.

Basilar artery: Patent

PCAs: Patent

PICAs: Patent

AICAs: Patent

SCAs: Patent

No acute fracture or soft tissue abnormality. No significant stenosis or filling defect in the bilateral internal jugular veins, sigmoid sinuses, transverse sinuses, straight sinus, inferior sagittal sinus, or superior sagittal sinus.

CTA NECK:

No aneurysm, high-grade stenosis, or dissection.

Aortic arch: Patent

Common Carotids: Patent

ICAs: Patent

Vertebral arteries: Patent

Veins of the Neck: Patent

No acute fracture. Soft tissues of the suprahyoid and infrahyoid neck are unremarkable. Salivary glands are unremarkable. No lymphadenopathy. Thyroid is unremarkable. Visualized lungs are clear.

IMPRESSION:

CT head:

1. No acute intracranial abnormality.

CT perfusion:

1. Technically inadequate study. No gross abnormalities however are seen.

CTA head:

1. No hemodynamically significant stenosis of the major arteries of the head.

2. No hemodynamically significant stenosis of the major veins of the head.

CTA neck: 1. No hemodynamically significant stenosis of the major arteries of the neck.
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Indication: Right gaze preference, left weakness after first time seizure. Hyperreflexia.

TECHNIQUE: MR images of the brain and cervical spine were performed before and after administration of gadolinium.

FINDINGS:

Brain:

There is no evidence of restricted diffusion to suggest an acute infarction. There is dural enhancement bilaterally overlying the convexities. There is high signal intensity in the anterior right frontal lobe seen best on series 15 image 32 and along the medial parafalcine left frontal lobe.

The post contrast scans shows absence of enhancement of the superior sagittal sinus over the vertex. This is seen in retrospect on the October 23, 2020 CT angiogram as well.

Susceptibility weighted scans show no evidence of intracranial hemorrhage. There is a developmental venous anomaly seen in the right parietal lobe.

Cervical spine:

The alignment of the vertebral bodies is normal. The signal intensity of the spinal cord is normal. There is no evidence of pathologic enhancement of the spinal cord. The soft tissues of the neck are unremarkable.

IMPRESSION:

Abnormal signal intensity in the right anterior frontal lobe and medial aspect of the left paramedian frontal lobe with decreased visualization of the superior sagittal sinus. This likely represents superior sagittal sinus thrombosis with venous ischemia without infarction seen on the diffusion-weighted imaging.
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Indication: Seizure. Headache.

Technique: Thin helical axial noncontrast CT sections of the head.

Sagittal and coronal reconstructed images created from standard and bone algorithm data sets.

Findings:

The ventricles and sulci are normal in size and configuration.

No abnormal areas of attenuation in the brain.

Visualized paranasal sinuses and mastoid air cells clear.

No fracture or concerning bone lesions.

Impression: Normal noncontrast head CT.