Answer for BIR CoW 06 April 2025
Dural sinus thrombosis involving straight sinus , left transverse sinus and sigmoid sinus extending into vein of Galen and bilateral internal cerebral vein
Findings
Plain CT Shows hyperdensity in straight sinus, vein of Galen , Bilateral Internal cerebral vein- both cord sign & hyperdense triangle sign seen. Hypodensity noted in left thalamus. CT Venogram shows Filling defect noted in straight sinus ( Empty Delta Sign), left transverse sinus, left sigmoid sinus extending into vein of Galen and bilateral internal cerebral vein. Other sinus appears normal opacification with contrast. DIAGNOSIS: Dural sinus thrombosis involving straight sinus , left transverse sinus and sigmoid sinus extending into vein of Galen and bilateral internal cerebral vein. TEACHING POINT: “PLAIN CT WITH CT VENOGRAM” is sufficient to diagnose dural sinus thrombosis in acute emergency setting.
Discussion
Cerebral dural sinus thrombosis is thrombotic occlusion of one more intracranial venous sinuses. Occur either in isolation or in combination with cortical and / or deep venous occlusions. Etiology: includes both inherited & acquired conditions. Common causes: OCPs, prothrombotic conditions,puerperium, pregnancy, metabolic cause includes dehydration , thyrotoxicosis Less common: Infection, trauma, neoplasm –related. Rare but important: Collagen vascular disorders, polycythemia, vasculitis. Location: transverse sinus is most commonly affected, followed by superior sagittal sinus, straight sinus & cavernous sinus. Epidemiology: Seen in young individuals, predominately affects women. Presentation: headache , nausea, vomiting, impaired consciousness.
IMAGING: NECT: Early signs often subtle, slight hyperdensity of sinus or cortical veins may be the only hint . CORD SIGN- Hyperattenuating vein, DENSE TRIANGLE SIGN-hyperdense dural sinus is sensitive & specific sign of cerebral venous occlusive disease. Parenchymal edema with or without petechial hemorrhage in the territory drained by the thrombosed sinus- indirect sign of Dural sinus thrombosis. CECT: EMPTY DELTA SIGN: Enhancing dura surrounding non enhancing thrombus CT Venogram – best noninvasive method . Readily demonstrates the classic Empty Delta sign. Differential Diagnosis: Hypoplastic /absent sinus. Giant Arachnoid granulations. Reference: Osborn brain –imaging, pathology & Anatomy.
Findings
Plain CT Shows hyperdensity in straight sinus, vein of Galen , Bilateral Internal cerebral vein- both cord sign & hyperdense triangle sign seen. Hypodensity noted in left thalamus. CT Venogram shows Filling defect noted in straight sinus ( Empty Delta Sign), left transverse sinus, left sigmoid sinus extending into vein of Galen and bilateral internal cerebral vein. Other sinus appears normal opacification with contrast. DIAGNOSIS: Dural sinus thrombosis involving straight sinus , left transverse sinus and sigmoid sinus extending into vein of Galen and bilateral internal cerebral vein. TEACHING POINT: “PLAIN CT WITH CT VENOGRAM” is sufficient to diagnose dural sinus thrombosis in acute emergency setting.
Discussion
Cerebral dural sinus thrombosis is thrombotic occlusion of one more intracranial venous sinuses. Occur either in isolation or in combination with cortical and / or deep venous occlusions. Etiology: includes both inherited & acquired conditions. Common causes: OCPs, prothrombotic conditions,puerperium, pregnancy, metabolic cause includes dehydration , thyrotoxicosis Less common: Infection, trauma, neoplasm –related. Rare but important: Collagen vascular disorders, polycythemia, vasculitis. Location: transverse sinus is most commonly affected, followed by superior sagittal sinus, straight sinus & cavernous sinus. Epidemiology: Seen in young individuals, predominately affects women. Presentation: headache , nausea, vomiting, impaired consciousness.
IMAGING: NECT: Early signs often subtle, slight hyperdensity of sinus or cortical veins may be the only hint . CORD SIGN- Hyperattenuating vein, DENSE TRIANGLE SIGN-hyperdense dural sinus is sensitive & specific sign of cerebral venous occlusive disease. Parenchymal edema with or without petechial hemorrhage in the territory drained by the thrombosed sinus- indirect sign of Dural sinus thrombosis. CECT: EMPTY DELTA SIGN: Enhancing dura surrounding non enhancing thrombus CT Venogram – best noninvasive method . Readily demonstrates the classic Empty Delta sign. Differential Diagnosis: Hypoplastic /absent sinus. Giant Arachnoid granulations. Reference: Osborn brain –imaging, pathology & Anatomy.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!