Wk 3, Case 5 - Review

Patient History

Patient with known vaccine-induced immune thrombotic thrombocytopenia presents with headache and right-sided neck pain.

Findings

CT Venogram Head:

No acute intra-axial or extra-axial fluid collection. No intracranial hemorrhage. No midline shift. No hydrocephalus. No CT evidence of acute infarction.

Complete occlusion of the right transverse sinus beginning at the torcula with expansile thrombus, which extends into the right sigmoid sinus and proximal right internal jugular vein. Mild dural enhancement along the margin of the right transverse and sigmoid sinus.

Remaining dural venous sinuses are patent, including the superior sagittal sinus, left transverse and sigmoid sinuses. Normal contrast opacification of the internal cerebral veins, vein of Galen, straight sinus, and the torcula.

Intracranial arterial vasculature is grossly unremarkable without evidence of occlusion, high-grade stenosis, or aneurysm on this limited evaluation performed on the venous structures.

Mastoid air cells, orbits, and paranasal sinuses are normal.

CT Neck:

Thrombus within the right jugular bulb extends to involve the superior aspect of the internal jugular vein, which is collapsed. Inferior right internal jugular vein is patent. Left internal jugular vein is patent with no evidence of thrombosis.

Carotid and vertebral arteries are patent.

Soft tissues of the neck are unremarkable. Parotid glands, submandibular glands, and thyroid are normal. Lung apices are unremarkable.

Multilevel degenerative changes of the cervical spine, severe at C5-C6 with moderate narrowing of the canal and moderate narrowing of the foramina bilaterally.

MR Venogram Head:

Similar configuration of occlusive thrombus beginning at the origin of the right transverse sinus and extending into the right sigmoid sinus and proximal right jugular vein.

Remaining dural venous sinuses are patent, including the superior sagittal sinus, internal cerebral veins, vein of Galen, straight sinus, and left transverse and sigmoid sinuses. Patent cortical veins.

Mild narrowing of the left internal jugular vein just below the skull base. Prominent mastoid emissary veins. Prominence of the vertebral venous plexus bilaterally.

Conclusion

1. Dural venous sinus thrombosis with occlusion of the right transverse and sigmoid sinus extending to the jugular bulb and superior right internal jugular vein.

2. No CT evidence of associated acute hemorrhage, edema, or infarct.