Answer for BIR CoW 29 Nov 2020
Subacute Straight Sinus thrombosis with Bilateral Acute Thalamic Infarcts
Findings
Acute infarcts noted involving bilateral thalami with blooming foci and minimal edema . Multiple acute lacunar infarcts noted in the right centrum semiovale , right corona radiata and right frontal white matter . Absent T2 flow void is observed in the straight sinus and internal cerebral veins with gradient blooming in SWI images and T1 hyperintensity , reflecting subacute Thrombosis MR venogram : Straight sinus and internal cerebral veins are not visualized. These features were consistent with diagnosis of Subacute Cerebral venous thrombosis involving straight sinus and internal cerebral veins with acute venous infarcts involving bilateral thalami , right centrum semiovale , right corona radiata , right frontal white matter.
Discussion
Cerebral Venous Thrombosis is Defined as thrombotic occlusion of one or more intracranial venous sinuses. It can occur in isolation or in combination with cortical and/or deep venous occlusions. Causes are myraid and include: Oral contraceptives Prothrombotic conditions Deficiency of protein C, S or antithrombin III Resistance to activated protein C ( V Leiden ) Hyperhomocysteinemia Puerperium , pregnancy Metabolic ( dehydration , thyrotoxicosis ) Hematologic disorders Vasculitis IMAGING FEATURES Transverse sinus is most commonly involved , followed by Superior sagittal sinus NECT FINDINGS : Cord sign – Hyperdense sinus CECT FINDINGS : Empty delta sign – enhancing dura surrounding non enhancing thrombus MR FINDINGS : Fat sinus sign – Thrombosed sinus appears enlarged Hyperintense on T1 weighted image Acute venous clots bloom on gradient images . MRV – absent flow in the involved sinus DEEP CEREBRAL VENOUS THROMBOSIS CT FINDINGS : Hyperdense internal cerebral veins & straight sinus Hypodense fading or disappearing thalami with effacement of border between the deep gray nuclei and internal capsule. MR FINDINGS : isointense on T1WI , hypointense on T2WI Blooming foci noted in SWI Venous congestion causes hyperintensity with swelling of thalami & basal ganglia on T2/FLAIR
Findings
Acute infarcts noted involving bilateral thalami with blooming foci and minimal edema . Multiple acute lacunar infarcts noted in the right centrum semiovale , right corona radiata and right frontal white matter . Absent T2 flow void is observed in the straight sinus and internal cerebral veins with gradient blooming in SWI images and T1 hyperintensity , reflecting subacute Thrombosis MR venogram : Straight sinus and internal cerebral veins are not visualized. These features were consistent with diagnosis of Subacute Cerebral venous thrombosis involving straight sinus and internal cerebral veins with acute venous infarcts involving bilateral thalami , right centrum semiovale , right corona radiata , right frontal white matter.
Discussion
Cerebral Venous Thrombosis is Defined as thrombotic occlusion of one or more intracranial venous sinuses. It can occur in isolation or in combination with cortical and/or deep venous occlusions. Causes are myraid and include: Oral contraceptives Prothrombotic conditions Deficiency of protein C, S or antithrombin III Resistance to activated protein C ( V Leiden ) Hyperhomocysteinemia Puerperium , pregnancy Metabolic ( dehydration , thyrotoxicosis ) Hematologic disorders Vasculitis IMAGING FEATURES Transverse sinus is most commonly involved , followed by Superior sagittal sinus NECT FINDINGS : Cord sign – Hyperdense sinus CECT FINDINGS : Empty delta sign – enhancing dura surrounding non enhancing thrombus MR FINDINGS : Fat sinus sign – Thrombosed sinus appears enlarged Hyperintense on T1 weighted image Acute venous clots bloom on gradient images . MRV – absent flow in the involved sinus DEEP CEREBRAL VENOUS THROMBOSIS CT FINDINGS : Hyperdense internal cerebral veins & straight sinus Hypodense fading or disappearing thalami with effacement of border between the deep gray nuclei and internal capsule. MR FINDINGS : isointense on T1WI , hypointense on T2WI Blooming foci noted in SWI Venous congestion causes hyperintensity with swelling of thalami & basal ganglia on T2/FLAIR
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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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!