PMC8422498_01
(a) MRI brain T2-weighted-GRE axial view showing right parietal hemorrhage. (b) MR venogram 2D TOF MIP coronal view showing complete thrombosis of the left transverse and sigmoid sinuses and partial thrombosis of superior sagittal sinus. (c) CT venogram 3D volume rendering technique showing complete thrombosis of the left transverse and sigmoid sinuses and partial thrombosis of superior sagittal sinus. (d) CT brain axial view showing increase in midline shift. (e) CT axial view after right parietal decompression craniectomy.
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F1
A magnetic resonance imaging (MRI) of brain [Figure 1a] showed a large right parietal hemorrhage with mild adjacent peri-focal edema, causing mass effect on adjacent right lateral ventricle and locoregional effacement of sulci and gyri, with a mid-line shift of 5 mm to the left. CT venogram [Figure 1b] and 3D volume rendering technique [Figure 1c] showed thrombosis of the left transverse and sigmoid sinuses and partial thrombosis of superior sagittal sinus. On day 2 in ICU, her sensorium acutely deteriorated and a CT brain showed significant increase in the right parietal hematoma and worsening midline shift of 10 mm [Figure 1d]. She underwent emergency right parietal decompressive hemicraniectomy with evacuation of the intracranial hematoma [Figure 1e], following which she remained intubated, on mechanical ventilation and sedated.
Platelet count response in the patient following IVIG infusion. IVIG: Intravenous immunoglobulin.
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The same day, her platelet count was noted to drop to 105 x 109/L, with a further fall to 69 x 109/L on day 3 [Figure 2].