Table 1.
Summary of clinical and radiographic findings
| Pt | Age, y | Presenting symptoms | Treatment/procedures | Location of thrombus on CT venography | Noncontrast CT | CT perfusion | MR imaging | Outcomes |
|---|---|---|---|---|---|---|---|---|
| 1 | 28 | Headache, confusion, R hemiparesis (fig. 1) | Diagnostic angiogram, microcatheter tPA drip | Posterior 1/3 of SSS, STS, R and L TS, R SS, R JV | Hyperdensity of SSS | CBV: ↑ R occipital and parietal area and R cerebellum CBF: ↑ R parietal MTT: ↑ R occipital area TTP: ↑ R cerebellum | Bilateral DWI and FLAIR hyperintensities along SSS | R hemiparesis resolved, persistent headaches |
| 2 | 18 | Headache, R hemiparesis | Heparin drip, diagnostic angiogram | Anterior 2/3 of SSS | Hyper density of anterior 2/3 of SSS | CBV: ↑ bilateral frontal CBF: ↓ bilateral frontal MTT:↑ bilateral frontal TTP: ↑ bilateral frontal | Hyperintensity L frontal DWI | Fully recovered |
| 3 | 36 | Headache, seizure | Heparin drip, thrombectomy, tPA drip | Anterior 2/3 of SSS | Hyper density of anterior 2/3 of SSS, L frontal hypodensity | CBV: ↑ bilateral frontal CBF: ↑ bilateral frontal MTT:↑ bilateral frontal TTP: ↑ bilateral frontal | Hyperintensity on DWI and FLAIR in L frontal along SSS | Fully recovered |
| 4 | 18 | Headache, confusion | Heparin bridge to Coumadin | L TS | Hyper density of L transverse sinus | Symmetric | Normal DWI and FLAIR | Persistent headaches |
| 5 | 30 | Coma | Heparin drip, thrombectomy, microcatheter tPA drip | SSS, R TS, R SS, R JV | Hyperdensity within SSS, R TS, R SS; patchy hypodensities of right frontal, parietal | CBV: ↑ R frontal, temporal, parietal, occipital CBF: ↑ R temporal, parietal, occipital MTT: ↑ R frontal, temporal, parietal, occipital TTP: ↑ R frontal, temporal, parietal, occipital | Multiple bilateral frontal, parietal, occipital DWI and FLAIR hyperintensities | Fully recovered |
| 6 | 24 | L leg weakness, headache (fig. 2) | Heparin drip to Coumadin | Anterior 1/2 of SSS | Normal | CBV: symmetric CBF: symmetric MTT: ↑ bilateral frontal TTP: ↑ bilateral frontal | Hyperintensity R frontal on DWI; FLAIR – normal | Near-complete resolution of L leg weakness |
| 7 | 73 | Seizure (fig. 3) | Heparin drip to Coumadin | Posterior 1/2 of SSS, R TS, R SS, R JV | 3 cm L frontal ICH; hyperdensity within SSS, R TS, R SS | CBV: ↓ L frontal corresponding to location of ICH CBF: ↓ L frontal corresponding to location of ICH MTT: ↓ L frontal corresponding to location of ICH TTP: ↑ bilateral parietal and occipital | Not done | Mild R hemiparesis |
| 8 | 55 | R hemiparesis, aphasia | Heparin drip to Coumadin | SSS, L TS, L SS | Hyperdensity within SSS; focal hypodensity of L frontal cortex | CBV: ↑ L frontal, parietal CBF: symmetric MTT: ↑ L frontal, parietal TTP: ↑ L frontal, parietal | Not done | Fully recovered |
| 9 | 49 | Headache, seizure, L hemiparesis (fig. 4) | Heparin drip to Coumadin, cerebral angiogram with mechanical thrombectomy | SSS, R TS, R SS | Hyperdensity within posterior SSS; R frontal ICH with surrounding hypodensity | CBV: ↓ R frontal corresponding to location of ICH CBF: ↓ R frontal corresponding to location of ICH MTT: ↓ R frontal corresponding to location of ICH TTP: ↑ R frontal, parietal | Not done | Fully recovered |
| 10 | 30 | Headache, R hemiparesis | Heparin drip, cerebral angiogram with mechanical thrombectomy | Posterior 1/3 and anterior 1/3 SSS, STS, bilateral TS | Hypodensity of L frontoparietal area | CBV: ↓ L frontal and parietal, adjacent to SSS CBF: ↓ L frontal and parietal, adjacent to SSS MTT: ↓ L frontal and parietal, adjacent to SSS TTP: ↑ L frontal, parietal and occipital | Not done | Mild R hemiparesis |
DWI = Diffusion-weighted imaging; ICH = intracranial hemorrhage; L = left; JV = jugular vein; Pt = patient; R = right; SS = sigmoid sinus; SSS = superior sagittal sinus; STS = straight sinus; tPA = tissue plasminogen activator; TS = transverse sinus; y = years.