case_images: PMC11807417_01
case_images: Initial CT brain (15/09/24) image reported showing no acute abnormalities. The red arrows indicate areas of hyperdensity that, in retrospect, could represent thrombi on a non-contrast scan. The blue arrows indicate areas where there is no flow on the CT angiogram, demonstrated by a lack of hyperdense white contrast, further indicating the presence of a thrombus. Although not a dedicated venogram, there is a filling of venous sinuses visible superior to the blue arrows.
case_images: cureus-0017-00000077246-i01.jpg
case_images: PMC11807417_01_cureus-0017-00000077246-i01.jpg
case_images: FIG1
case_images: A computed tomography (CT) angiogram of the brain and neck was performed, revealing no acute abnormalities, as illustrated in Figure 1.
case_images: Initial MRI of the brain (16/09/24) showed the focal area of altered F2/fluid-attenuated inversion recovery (FLAIR) signal intensity on the left. The image on the right is a post-contrast T1-weighted (T1W) sequence.
case_images: cureus-0017-00000077246-i02.jpg
case_images: PMC11807417_01_cureus-0017-00000077246-i02.jpg
case_images: FIG2
case_images: Magnetic resonance imaging (MRI) of the brain with contrast was performed on 16/09/2024 (Figure 2 and Figure 3), revealing a focal area of altered signal intensity in the left inferior frontoparietal lobe around the inferior portion of the central sulcus, measuring approximately 22 mm in maximum dimension.
case_images: Magnetic resonance susceptibility-weighted imaging (MR SWIP) (16/09/24) on the left showed abnormally thickened blood vessels suspicious for thrombi. Magnetic resonance gadolinium (MR GAD) contrast on the right side showed areas of reduced contrast enhancement, corresponding to areas on MR SWIP. This was not commented on in the initial report.
case_images: cureus-0017-00000077246-i03.jpg
case_images: PMC11807417_01_cureus-0017-00000077246-i03.jpg
case_images: FIG3
case_images: Magnetic resonance imaging (MRI) of the brain with contrast was performed on 16/09/2024 (Figure 2 and Figure 3), revealing a focal area of altered signal intensity in the left inferior frontoparietal lobe around the inferior portion of the central sulcus, measuring approximately 22 mm in maximum dimension.
case_images: A follow-up MRI of the brain (19/09/24) image showed a reduced T2/fluid-attenuated inversion recovery (FLAIR) signal indicated on the image on the left. Magnetic resonance susceptibility-weighted imaging again showed abnormally vessel thickening corresponding to thrombi.
case_images: cureus-0017-00000077246-i04.jpg
case_images: PMC11807417_01_cureus-0017-00000077246-i04.jpg
case_images: FIG4
case_images: The third brain MRI (01/11/24) image showed the resolution of T2/fluid-attenuated inversion recovery (FLAIR) hyperintensity in the image on the left. The right-sided image also showed T2/FLAIR hyperintensity in regions previously corresponding to areas of thrombus.
case_images: cureus-0017-00000077246-i05.jpg
case_images: PMC11807417_01_cureus-0017-00000077246-i05.jpg
case_images: FIG5
case_images: A CT venogram image showed bilateral cerebral venous sinus thrombosis. Note the image on the left is similar in appearance to the computed tomography angiogram (CTA) performed on 15/9/24 in Figure 1. A subtle filling defect was visible in the right lateral superior sagittal sinus, suggestive of a non-occlusive thrombus indicated by the arrow on the right panel.
case_images: cureus-0017-00000077246-i06.jpg
case_images: PMC11807417_01_cureus-0017-00000077246-i06.jpg
case_images: FIG6
case_images: A CT venogram was subsequently performed on 05/11/2024 (Figure 6), confirming the presence of bilateral CVST.