E2534. Cerebral Dural Venous Sinus Thrombosis on Noncontrast CT Head: A Case Series
  1. Rachana Borkar; Bridgeport Hospital
  2. Aishwariya Vegunta; Bridgeport Hospital
  3. Namita Bhagat; Bridgeport Hospital
  4. Gaurav Cheraya; Bridgeport Hospital
Cerebral venous sinus thrombosis (CVST) is a rare condition, accounting for 0.5% of all cerebrovascular disease. Most patients (87.5%) have predisposing conditions, with more than one coexistent risk factor. CVST can present in a wide spectrum of symptoms from asymptomatic to coma and death. It is important to be aware of the findings on noncontrast CT for patients presenting in the ED to be able to make the pertinent diagnosis. Here we present two cases with incidental dural venous sinus thrombosis found on noncontrast CT head at our institution and two cases with CVST mimics.

Educational Goals / Teaching Points
Remain aware of direct and indirect signs of CVST on non contrast computed tomography (CT), prompt communication of findings with clinical team, and recommend pertinent follow up imaging for definitive diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The most prevalent type of CVST is dural sinus thrombosis. It is thrombotic occlusion of one or more dural sinuses. The superior sagittal sinus is most commonly affected, followed by the transverse sinus. Deep cerebral venous thrombosis involves the internal cerebral veins, vein of Galen, the basal veins of Rosenthal and their tributaries. The straight sinus is usually included with the deep cerebral veins. Involvement of the deep cerebral veins is present in approximately 10% of all patients with CVST and is often seen along with sinus thrombosis. Cortical venous thrombosis (CVT) indicates thrombosis of the superficial cortical veins including the anastomotic vein of Labbe. CVT most commonly affects the frontal cortical veins, followed by the parietal veins. We describe two cases seen on emergent NCCT head obtained for symptoms ranging from headache to aphasia. Imaging features on NCCT head including (cord sign - cordlike hyperdensity within a dural venous sinus on non-contrast enhanced CT of the brain, especially within the transverse sinus), dense vein sign (hyperdensity with dural sinuses or cerebral veins), non-territorial parenchymal hypodensity due to venous hypertension, and unilateral or bilateral superficial parenchymal hemorrhage. Failure to identify CVST causes adverse outcomes in the majority of patients, whereas timely anticoagulation or mechanical thrombectomy directed towards CVST resolution, has favorable outcomes in up to 80% patients. It is necessary to be prudent and try to rule out obvious mimics such as hyperdense sinuses in patients with raised H&H and artefactual defects on postcontrast CT done for other purposes.

CVST is a diagnosis with grave outcomes if not diagnosed in a timely manner. NCCT head is usually the first and sometimes the only cranial imaging in patients presenting in emergency departments with vague presentations. It may sometimes accompany osseous cranial injury in trauma patients presenting subacutely. Being aware of subtle imaging findings in the current postpandemic scenario and other patient populations with increased coagulability is of significance in preventing morbidity and mortality. Awareness of and ability to rule out mimics from pertinent labs and history is also discussed.