35-year old gentleman presented with episodes of headache for the past two weeks. There were no other significant past history.
CT brain showed features of 1. Right transverse sinus thrombosis (red arrow), 2. Internal cerebral veins thrombosis (thin yellow arrow), 3. Straight sinus thrombosis (orange arrow), 4. Superior sagittal sinus thrombosis (thick yellow arrow)
MR Venography showed features of extensive venous sinus thrombosis, with multiple collaterals. This was suggestive of chronic venous sinus thrombosis. Collaterals are appearing tortuous, and a possibility of dural arterio-venous fistula should be kept in mind. A cerebral angiogram may be needed.
He was started on low molecular weight heparin injection, with which he had a good response. Work up for the causes of venous thrombosis is awaited.