Imaging Pearl for cerebral venous sinus thrombosis

Courtesy of David Lee Gordon, Chairman Oklahoma (the neurology department not the musical)

Look at the parenchymal MRI (not MRV) images, particularly the T1noncontrast sagittal images. If the noncontrast T1 sagittal images shownormal (hypointense = black) flow void in the left transverse sinus andlack of flow void (hyperintense = white) in the right transverse sinus,you have your answer without a venogram.The left transverse sinus is commonly hypoplastic, not the right (sinceuually the right transverse sinus drains the larger superior sagittalsinus and the left transverse sinus drains the smaller straight sinusand the confluence is usually not a confluence at all). Also a temporalhemorrhage is precisely what I would expect from an ipsilateraltransverse sinus thrombosis. If the patient does indeed have CVT,anticoagulation often leads to improve despite the presence ofhemorrhage.