Cerebral Sinus and Venous Thrombosis

A 54-year-old male patient presented with a history of headache for 8 days which was acute on onset, located over the occipital and nape of the neck region, throbbing in character, without any radiation, associated with mild blurring of vision without diplopia, aggravated with strenuous activities, and in supine position. Headache was progressively increasing in severity over the days, associated with nausea and vomiting. He also had three episodes of generalized tonic-clonic movements lasting for 1 min for 1 day. Following the last seizure episode, he developed weakness of right upper and lower limbs. There was no history of fever, ear discharges, loose stool, trauma, diplopia, dysphagia, or dysarthria. There was no history of smoking, alcohol, or any chronic illness. His vitals were stable. On examination, he was found to be plethoric. Fundus examined was normal. His higher mental function was intact, no meningeal signs, and normal cranial nerves. His motor examination revealed power of 4−/5 over the right upper and lower limbs across all the joints, reflexes of 3+ and an upgoing planter over the right. All sensory modalities were normal. Coordination and gait were intact and normal. His investigations revealed hemoglobulin of 18.6 g/dL and a hematocrit of 51%, and the rest of his routine blood parameters were normal. Chest X-ray, ultrasonography abdomen and pelvis, echocardiography, and arterial blood gas were normal. His contrast tomography (CT) head plain showed a hyperdense lesion over the left parietal deep white matter, and hyperdensities were present over the straight sinus and superior sagittal sinus region (Fig. 13.1a, b). His magnetic resonance imaging (MRI) showed T2 high-signal changes with central hypointensity over the left frontal and parietal cortical areas, suggestive of acute hemorrhage (Fig. 13.1c). His magnetic resonance venogram (MRV) revealed a filling defect over the superior sagittal sinus (Fig. 13.1d).