Case 8 - Cortical Vein Thrombosis 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 head/brain without contrast.

INDICATION: 35-year-old male who presents with seizure and altered mental status. Per note, patient had left upper extremity and left lower extremity weakness.

TECHNIQUE: Unenhanced axial CT images through the head/brain from the base of the skull to the vertex were obtained and reviewed. Coronal and sagittal reformats were generated from the axial data.

COMPARISON: 12/6/2004 CT head

FINDINGS:

There is a hypodense region in the white matter of the right parieto-occipital region that appears to spare the cortex, and may indicate infarct of unknown chronicity.

Hyperdense cortical vein in the right posterior vertex, which can be seen in venous thrombosis.

No acute intra or extra-axial hemorrhage identified. No mass, mass effect, or midline shift is seen.

The ventricular system and sulci are symmetric, and unremarkable for patient's age.

The basal cisterns are patent. Calvarium and skull base intact.

The orbits are symmetric and unremarkable.

The visualized paranasal sinuses are unremarkable.

The mastoid air cells and middle ear cavities are clear.

IMPRESSION:

1. Right parieto-occipital hypodense region that appears to spare the cortex, suggesting infarct of unknown chronicity.

2. Hyperdense cortical vein in the right posterior vertex, suggestive of venous thrombosis.

3. These findings may indicate cerebral venous infarction; consider dedicated MRV or CTV for further evaluation.
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EXAM: CT head without contrast

INDICATION: Venous infarction

TECHNIQUE: Axial CT examination of the head was performed without intravenous contrast. Coronal and sagittal reformats were generated with the axial data set.

COMPARISON: Multiple prior examinations from 9/1/2019.

FINDINGS:

Increased hypodensity within the right parieto-occipital lobe compatible with interval evolution of right parieto-occipital venous infarct. Hyperdense overlying cortical vein, right posterior vertex, is unchanged in appearance when compared to prior exams from 9/1/2019.

No intracranial hemorrhage. No mass, mass effect or midline shift. Ventricles and sulci appropriate for patient's age. Basal cisterns are patent. Brainstem and cerebellum unremarkable. Calvarium intact.

Paranasal sinuses, mastoids clear. Orbits symmetric and unremarkable.

IMPRESSION:

1. Continued interval evolution of right parieto-occipital venous infarct with increased hypodensity throughout the infarct zone.

2. Unchanged overlying hyperdense cortical vein at the right posterior vertex, likely chronically thrombosed.

3. No intracranial hemorrhage or new infarction