1. IMAGE OF THE WEEK
PROF.DR.G.SUNDARAMURTHY
M2 UNIT
P-VANJI NATHAN

2. CLINICAL HISTORY AND
EXAMINATION
 35 year old male patient, a chronic alcoholic
presented to casualty with history of
headache 1 week, sudden onset,
gradual progression,
associated with blurring of vision.
An episode of vomiting X 1 day.
 O/E Patient was conscious oriented, looked
distressed and had R lateral rectus palsy (diplopia)
on CNS examination.
 Urgent imaging (CT-Brain) was done,

6. FOLLOWING THE ABNORMAL CT
FINDINGS, MRI BRAIN WAS TAKEN

11. CT-BRAIN REPORT
 CT BRAIN AXIAL SECTIONS SHOWING
1. HYPERDENSITY IN THE RIGHT FRONTAL
REGION
2. HYPERDENSITY IN THE R TRANSVERSE
SINUS
3. HYPODENSITY IN THE SUPERIOR SAGITTAL
SINUS (?EMPTY DELTA SIGN)
 SUGGESTIVE OF ?PARENCHYMAL
HEMORRHAGE WITH CORTICAL VEIN
THROMBOSIS ?CALCIFIED GRANULOMA.

12. 1
22
3

13. MRI BRAIN REPORT
 MRI brain shows T1 hyperintense / non
suppressible T2 hyperintensity in the right
high parietal lobe. The lesion shows
peripheral blooming in T2 gradient sequence
suggestive of hemorrhage.
 Absence of flow voids in mid sagittal and
transverse sinus in FLAIR images suggestive
of sinus thrombosis
 T1 hyperintensity noted in superior sagittal
sinus and right transverse sinus suggestive of
thrombosis.
 MR venography confirms the evidence of
thrombosis in superior sagittal sinus and right
transverse sinus.

14. T2 hyper
intensity
Gradient
blooming
T1
hyperintensity
FLAIR
FLOW
VOID

16. CEREBRAL VEINS-VALVELESS,THIN
EXTERNAL
SUPERIOR MIDDLE
SUPER
FICIAL
DEEP
CAVERNOUS OR
SPHENOPARIETAL
SINUSSUPERIOR
SAGITTAL
SINUS
BASAL
VEIN
INTERNAL-2 IN
NUMBER- JOIN TO
FORM GREAT
CEREBRAL VEIN
INFERIOR
SUP.CER.VN
OR CAV.SIN.
BASAL VN
RECEIVES

19. CT FINDINGS IN CVT
 Dense clot sign - Areas of thrombosis in sinuses
appearing as hyperdensities in unenhanced ct.
 Cord sign - Dense cortical veins-uncommon direct
sign of cvt in unenhanced ct.
 Venous infarction is the most non specific indirect
sign in unenhanced ct - presence of multiple
isolated lesions, subcortical involvement, more
than one arterial territory involved.
 Empty delta sign - Filling defect with enhancing
rim on enhanced ct.
 Contrast enhancement secondary to venous stasis
 Diffuse brain swelling with edema and decreased
ventricular size might be present.
 CT venogarhy allows direct visualisation of
thrombus.

21. MRI FINDINGS IN CVT
 Can confirmatively tell presence of CVT.
 Venous thrombus may be directly visualised.
 Patent dural sinuses are seen as flow void
especially when the image is orthogonal to blood
flow direction.
 Thrombus manifest as absence of flow void-best
seen in FLAIR and T2 weighted spin echo
sequences.
 T1 weighted - hyperintensity ; T2 weighted
gradient echo-exaggerated signal loss.
 MR venography - shows direct visualisation of
thrombus.