case_images: PMC3709281_01
case_images: Case 1. A 38-year-old woman on oral contraceptives presented with headache and difficulty speaking. She had no other significant past medical history. A left frontal subdural hematoma (white arrows, a, b; black arrow, c) and left temporal venous infarct (white arrow, c) with a left transverse sinus thrombosis (black arrow, d) was demonstrated on CT (a) and MR imaging (b, c, d). A hypercoagulable work-up did not reveal any additional thrombophilias
case_images: SNI-4-85-g001.jpg
case_images: PMC3709281_01_SNI-4-85-g001.jpg
case_images: F1
case_images: A left frontal SDH and left temporal venous infarct with a left transverse sinus thrombosis was demonstrated on CT and MRI [Figure 1].
case_images: PMC3709281_02
case_images: Case 2. A 68-year-old woman with polycythemia vera experienced a severe headache and then deteriorated to coma. At the time of craniotomy, the neurosurgeon observed a thrombosed cortical vein following evacuation of the subdural hematoma. A coronal CT head (a) demonstrates a left acute subdural hematoma (dashed arrow). CT venogram (b) is notable for the empty delta sign (solid arrow) due to intraluminal thrombus preventing normal opacification of the sagittal sinus. Genetic testing demonstrated the V617F mutation within the JAK2 gene
case_images: SNI-4-85-g002.jpg
case_images: PMC3709281_02_SNI-4-85-g002.jpg
case_images: F2
case_images: SDH with 16 mm of midline shift [Figure 2a]. She underwent emergent craniotomy and hematoma evacuation. CT venography and MR venography detected partial superior sagittal sinus thrombosis, which leads to the empty delta sign (the intraluminal thrombus prevents central filling of the sinus; Figure 2b).
case_images: PMC3709281_03
case_images: Case 3. A 60-year-old male presented with one month of escalating headaches and no history of trauma or use of antiplatelets or anticoagulants. CT head demonstrated a left isodense subdural hematoma (a). This was evacuated surgically with mini-craniotomy. The initial imaging on postoperative day one (POD#1, b) showed excellent radiographic results. Repeated imaging on postoperative day 27 (POD#27,, c) showed recurrence of the left isodense subdural hematoma
case_images: SNI-4-85-g003.jpg
case_images: PMC3709281_03_SNI-4-85-g003.jpg
case_images: F3
case_images: Noncontrasted head CT demonstrated a 19 mm left isodense SDH with 10 mm of midline shift [Figure 3a]. He underwent a mini-craniotomy; and repeat CT imaging after the procedure [Figure 3b] demonstrated excellent hematoma evacuation and brain reexpansion. A scheduled follow up head CT obtained on postoperative day 27 was notable for recurrent SDH with a frontal predilection  [Figure 3c].
case_images: Case 3. Catheter angiography (a and b) and venography (c and d) were performed. Right common carotid artery injection shows normal venous draining pattern (a). Left common carotid injection (b) shows stagnate flow in the vein of L abbe (black arrow), retrograde drainage via the right transverse sinus (dashed and open arrows), and a filling defect (black circle). Selective venography of the left transverse sinus (c) demonstrates back-filling of the vein of Labbe (black arrow) and elevated pressures. Following endovascular treatment (d), normal venous drainage and pressures are restored
case_images: SNI-4-85-g004.jpg
case_images: PMC3709281_03_SNI-4-85-g004.jpg
case_images: F4
case_images: Patient underwent cerebral angiography on postoperative day 7 after SDH evacuation [Figure 4].