19 September 2012

Deep Cerebral Venous Sinus Thrombosis with External Capsule Hemorrhage

Patient presented with acute hemorrhage in the right external capsule. Finding that was in the first place suspected for hypertension hemorrhage. However patient had no history of hypertension and just 5 days later developed another external capsule hemorrhage on the left side (second image). At this time there was also some diffuse low density noted in the basal ganglia suggesting extensive infarction. Following scan (third image) has shown advanced infarction extensively involving the basal ganglia. CT Cerebral Venous Angiography has revealed Deep Cerebral Venous Sinus Thrombosis. Note thrombus in sinus rectus (arrowheads). This is a case of Deep Cerebral Venous Sinus Thrombosis with External Capsule Hemorrhage. Teaching point here is that Cerebral Venous Thrombosis can manifest as hemorrhage. See my previous case of Sinus Thrombosis with SAB. Another important teaching point is that large infarctions in the basal ganglia can be associated with Deep Cerebral Sinus Thrombosis.