Projects

Tentorial sinovenous thrombosis (TSVT) is rarely considered in usual neurology practice. We found only one case report of tentorial venous thrombosis in the literature, suggesting its rarity or lack of awareness leading to underreporting. Here, we report a case of TSVT to raise awareness of this entity as a cause of hemorrhagic infarcts.

A 43-year-old woman with no known comorbidities presented to the emergency with an acute, severe holocranial headache of 4 hours duration. There was no history of head trauma or bleeding diasthesis. On admission, she was conscious and oriented, with a pulse of 80 beats per minute and a blood pressure of 150/90 mmHg. Neurological examination revealed bilateral papilledema with no lateralizing signs.

A noncontrast computed tomography (CT) scan of the brain done 4 h after the onset of symptoms showed a left temporal hemorrhage [Figure 1a]. Magnetic resonance imaging (MRI) of the brain done immediately after the CT scan showed hemorrhage in the left temporal lobe and along the left tentorium [Figure 1b]. Following this, a 3 Dimension (3D) time-of-flight (TOF) MR venography (MRV) performed 5 h after the brain MRI showed normal-appearing major dural venous sinuses, including the vein of Labbé [Figure 1c]. Axial susceptibility-weighted imaging (SWI) [Figure 1d] showed curvilinear hypointensities suggesting thrombosed tentorial veins transitioning into the tentorial sinus along the medial edge of the tentorium, and coronal SWI [Figure 1e] showed two discrete hypointensities suggesting a “cord sign” in the sinovenous system. Additionally, the coronal phase images [Figure 1f] showed a hypointense signal of paramagnetic dipole (deoxyhemoglobin) suggesting thrombosis.