PMC9192252_01
Magnetic resonance imaging (MRI) of the brain with contrast. (a) Postcontrast sagittal view showing extensive filling defect in the superior sagittal sinus consistent with thrombosis. (b) Diffusion weighted imaging (DWI) coronal view demonstrating left parietal lobe infarct (arrow) and hemorrhage (arrowhead).
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Initial magnetic resonance imaging (MRI) brain with and without contrast demonstrated extensive thrombosis and complete occlusion of the superior, straight, left transverse, and sigmoid sinuses extending into the left cortical draining veins proximally and into the left internal jugular vein distally (Figure 1).
Magnetic resonance imaging (MRI) of the brain with contrast, T2 flair showing left parietal lobe hemorrhagic infarct (arrow).
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DWI sequence which raised concern for venous infarction (Figure 2). Due to the extensive CVST, the patient was started on unfractionated heparin therapy with frequent/interval monitoring of activated partial thromboplastin time (aPTT) and the vaginal ring was removed. Repeat MRI brain with and without contrast showed persistent thrombosis and infarct (Figure 2).
Magnetic resonance imaging (MRI) of the brain with contrast, postcontrast sagittal view showing marked improvement in the previously seen filling defect in the superior sagittal sinus (arrows).
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Repeat MRI brain demonstrated improvement in clot burden and markedly reduced density of thrombosis with much improved intraluminal contrast flow (Figure 3).