Transverse Sinus Thrombosis

This 43 year-old male presented with right neck pain and right-sided headache for 3 days. Interestingly the pain was worse with eye movements. The patient had an episode of diarrhoea for 3 days prior to development of symptoms, with probable dehydration. This axial non-contrast CT shows high density in the right transverse sinus, consistent with acute thrombus (click image for arrow). Venous sinus thrombosis was confirmed with CT cerebral venogram.
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 MRI 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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