case_images: PMC8645635_01
case_images: (A) Time course of symptom onset, laboratory findings of platelet count (solid line)/D-Dimer (dashed line), and imaging studies. The x-axis represents the number of days after vaccination. (B-D) show sagittal contrast-enhanced T1-weighted MRI-sequences; (B) no evidence of thrombosis in the sagittal superior sinus at day 12 following vaccination; (C) thrombosis of the sagittal superior sinus (circle) at day 14 following vaccination; (D) regression of thrombosis at day 20 following vaccination.
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case_images: PMC8645635_01_fneur-12-763049-g0001.jpg
case_images: F1
case_images: C-reactive protein (CRP) value (103 mg/l), and increased D-dimers (5.83 mug/ml) (Figure 1A depicts the time course of symptoms and relevant laboratory results). Cranial MRI with venous angiography was performed because of headache on day 12 following vaccination, providing insignificant findings (Figure 1B). Because of the non-resolving headache, cerebral MRI was repeated (Figure 1C). Twenty days after vaccination, cranial MRI with venous angiography showed partial recanalization of thrombosis (Figure 1D).
case_images: PMC8645635_02
case_images: (A) Time course of symptom onset, laboratory findings of platelet count (solid line)/D-Dimer (dashed line), and imaging studies. The x-axis represents the number of days after vaccination. (B,C) show axial contrast-enhanced T1-weighted MRI-sequences: (B) no evidence of thrombosis in the left-sided lateral transverse sinus at day 8 following vaccination; (C) thrombosis in the left-sided lateral transverse (circle) sinus at day 18 following vaccination; (D) axial cranial CT showing a left-sided, space-occupying atypical intracranial hemorrhage (ICH) with subarachnoidal hemorrhage at day 21 following vaccination.
case_images: fneur-12-763049-g0002.jpg
case_images: PMC8645635_02_fneur-12-763049-g0002.jpg
case_images: F2
case_images: CRP elevation (52.4 mg/l) were apparent (Figure 2A depicts the time course of symptoms and relevant laboratory results). Cranial MRI with venous angiography was performed and yielded insignificant findings (Figure 2B). One day later, cranial MRI with venous angiography showed left-sided thrombosis in the internal jugular vein, sigmoid sinus, and lateral portion of the transverse sinus (Figure 2C). Cranial CT revealed a left-sided, space-occupying atypical intracranial hemorrhage (ICH) suitable for stasis bleeding in sinus thrombosis with concomitant subarachnoid hemorrhage (SAH) and marked midline shift (Figure 2D).