Transverse Sinus Thrombosis

This 37 year-old male with presented with headache. T1-weighted sagittal MRI shows high signal in the right transverse sinus (click image for arrows). There is also high signal on axial T2-weighted images, confirming a real abnormality (as opposed to entry-zone phenomenon).
Transverse sinus thrombosis may be complicated by venous infarction of ipsilateral parietoccipital regions or cerebellar hemisphere. There may also be oedema without infarction - diffusion-weighted imaging is helpful for differentiation. The mainstay of management is systemic heparinisation, with 80% favourable outcome vs 10% with placebo. Endovascular management includes clot extraction, local thrombolytic therapy, and mechanical clot disruption. Endovascular management is indicated when there is failure of anticoagulation, strong contraindications to anticoagulation, or a very high initial thrombus burden.
References:
1. Leach JL et al. Imaging of Cerebral Venous Thrombosis: Current Techniques, Spectrum of Findings, and Diagnostic Pitfalls. Radiographics. 2006; 26:S19-S43
2. Morris P. Interventional & Endovascular Therapy of the Nervous System. Springer 2002
Credit: Dr Laughlin Dawes
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