PMC8363077_01
Axial and coronal CT from patient 1 (A), 2 (B) and 5 (C). These patients presented with large parenchymal hemorrhages. Note the fluid-fluid levels [arrows, (A,C)], the subarachnoid hemorrhage [arrowheads, (A,C)] and the heterogeneous appearance of all hematomas.
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F1
Cerebral CT revealed right hemispheric parenchymal hemorrhage (Figure 1).
PMC8363077_02
Axial and coronal CT from patient 1 (A), 2 (B) and 5 (C). These patients presented with large parenchymal hemorrhages. Note the fluid-fluid levels [arrows, (A,C)], the subarachnoid hemorrhage [arrowheads, (A,C)] and the heterogeneous appearance of all hematomas.
fneur-12-721146-g0001.jpg
PMC8363077_05_fneur-12-721146-g0001.jpg
F1
Cerebral CT revealed right hemispheric parenchymal hemorrhage (Figure 1).
MRI of patient 4 (upper row) and patient 2 (lower row), axial T2-weighted images (A,D), axial T1-weighted images (B,E) and contrast-enhanced axial T1-weighted images (C,F). A complex signal in hematomas of venous infarctions in the right cerebellar hemisphere (patient 4) and left temporal lobe (patient 2) is seen. Multiple fluid-fluid levels (arrows) and sedimentation indicate not fully coagulated blood. Multifocal areas of high signal intensity within the hematoma represents extravasated contrast agent [arrow heads, (F)]. An acute thrombus in the right transverse and sigmoid sinus [open arrow, (C)] cause a well-defined filling defect on the contrast-enhanced T1-MPRAGE. The round lesion with low signal intensity on T2-weighted image [thick arrow, (D)] was tubular on consecutive slices, showed lack of contrast enhancement and is compatible with a cortical vein thrombosis.
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F2
CSVT in the inferior sagittal sinus, vein of Galen and straight, right transverse and sigmoid sinuses (Figure 2). CT pulmonary angiogram showed bilateral segmental pulmonary emboli and abdominal CT demonstrated thrombosis in uterine veins.
PMC8363077_03
MRI, CT, and CT venography of patient 3. Thrombosis in a cortical vein (thin arrows) is possible to spot with high signal intensity on axial FLAIR (A) and filling defect on contrast enhanced axial T1-MPRAGE (B). Corresponding temporo-occipital hemorrhage (open arrow), cerebellar hemorrhage and high attenuation from thrombus in transverse and sigmoid sinuses can be seen on coronal CT (E). 3D phase-contrast MR venography demonstrates loss of flow signal in left transverse and sigmoid sinus (D). The thrombus in sigmoid sinus (thick arrows) is also evident on contrast enhanced axial T1-MPRAGE (C) and CT venography (F).
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F3
ChAdOx1 nCoV-19, with a 2-day history of headaches, fever, transient numbness in the right foot and right sided visual disturbance. Cerebral CT and MRI demonstrated CSVT in the left transverse and sigmoid sinus, and left occipital CoVT (Figure 3).
PMC8363077_04
MRI of patient 4 (upper row) and patient 2 (lower row), axial T2-weighted images (A,D), axial T1-weighted images (B,E) and contrast-enhanced axial T1-weighted images (C,F). A complex signal in hematomas of venous infarctions in the right cerebellar hemisphere (patient 4) and left temporal lobe (patient 2) is seen. Multiple fluid-fluid levels (arrows) and sedimentation indicate not fully coagulated blood. Multifocal areas of high signal intensity within the hematoma represents extravasated contrast agent [arrow heads, (F)]. An acute thrombus in the right transverse and sigmoid sinus [open arrow, (C)] cause a well-defined filling defect on the contrast-enhanced T1-MPRAGE. The round lesion with low signal intensity on T2-weighted image [thick arrow, (D)] was tubular on consecutive slices, showed lack of contrast enhancement and is compatible with a cortical vein thrombosis.
fneur-12-721146-g0002.jpg
PMC8363077_04_fneur-12-721146-g0002.jpg
F2
CSVT in the inferior sagittal sinus, vein of Galen and straight, right transverse and sigmoid sinuses (Figure 2). CT pulmonary angiogram showed bilateral segmental pulmonary emboli and abdominal CT demonstrated thrombosis in uterine veins.
PMC8363077_05
Axial and coronal CT from patient 1 (A), 2 (B) and 5 (C). These patients presented with large parenchymal hemorrhages. Note the fluid-fluid levels [arrows, (A,C)], the subarachnoid hemorrhage [arrowheads, (A,C)] and the heterogeneous appearance of all hematomas.
fneur-12-721146-g0001.jpg
PMC8363077_05_fneur-12-721146-g0001.jpg
F1
Cerebral CT revealed right hemispheric parenchymal hemorrhage (Figure 1).
Autopsy findings in patient 5: (A) Coronal section of the formalin-fixed brain. Extensive hemorrhagic infarction (red arrows) in both hemispheres and major hemorrhage with communication to the brain surface and ventricular system. (B) Posterior sagittal sinus with a white thrombus. (C) Formalin fixed dura. Sagittal sinus with thrombus formation (arrow). (D) Cross-section of formalin fixed right transverse sinus with white thrombus (arrow).
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F4
Neuropathological examination demonstrated a white clot in the posterior sagittal sinus and both transverse sinuses (Figure 4). Massive hemorrhagic venous infarction was confirmed in the right parietal lobe and bilateral hemorrhagic infarctions in multiple cortical areas (Figure 4).