PMC9649923_01
Images from the patient who received mechanical thrombectomy and anticoagulation for aSDH with CVST. (A) Axial head CT demonstrating the mixed density acute subdural hematoma. (B) Axial head CT demonstrating hyperdensity in the torcula and transverse sinuses suggestive of acute thrombosis. (C) Sagittal CTV demonstrating occlusion of the SSS, straight sinus and torcula along with generalized venous congestion. (D) Right ICA injection, lateral projection of late venous phase demonstrating thrombus in the SSS and partial occlusion of the straight sinus and occlusion of the transverse sinuses. (E) Venogram of right sigmoid sinus, lateral projection after thrombectomy and tPA infusion showing improvement in drainage of the SSS and transverse sinus. Note there is a persistent non-occlusive thrombus of the transverse sinus. (F) Axial head CT demonstrating decreased size of the subdural hematoma.
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F1
A head computed tomography (CT) was obtained which showed the initial mixed density acute subdural hematoma (Figure 1A). An additional axial head CT demonstrated multifocal hyperdensities throughout the dural sinuses, highly concerning for multifocal acute dural sinus thrombosis (Figure 1B). Occlusions were identified in the superior sagittal sinus (SSS), torcula, bilateral transverse sinuses/sigmoid to the jugular bulb and straight sinus along with generalized venous congestion (Figure 1C). The final angiogram showed significant improvement in antegrade venous drainage in the SSS, bilateral transverse and sigmoid sinuses with residual multifocal non-occlusive thrombi (Figures 1D,E). A head CT obtained during the clinic follow up showed near complete resolution of the SDH (Figure 1F).
PMC9649923_02
Images from patient who underwent MMA embolization followed by anticoagulation for management of aSDH with CVST. (A) Axial head CT demonstrating an ill-defined intraparenchymal hemorrhage in the left temporal lobe concerning for a venous infarct. (B) Coronal CTV showing occlusion of the right transverse sinus. (C) Axial head CT demonstrating an acute left frontal subdural hematoma. (D) Axial head CT demonstrating decreased size of the left frontal subdural hematoma.
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F2
A head CT was obtained which demonstrated a left temporal intraparenchymal hemorrhage (Figure 2A). A CTV was obtained which demonstrated a thrombosis extending from the straight sinus through the right transverse sinus to the jugular vein (Figure 2B). A surveillance head CT was obtained, which demonstrated a slight interval enlargement of the subdural hematoma (Figure 2C). SDH (Figure 2D).