PMC4727609_01
Plain CT brain showing: A) SAH in paramedian sulci bilaterally over the left fronto-parietal region (cSAH), (arrow heads), and thrombosis of SSS (straight arrow). B) MRV 3D MIP image, anterior projection, demonstrate non-visualization of superior portion of SSS and draining veins. C) transverse and sigmoid sinus on the left side (straight arrows). D) FLAIR image, shows venous infarcts in frontal and parietal regions on both sides, (curved arrows). SAH - spontaneous subarachnoid hemorrhage, cSAH - convexity SAH, SSS - superior sagittal sinus, MRV - magnetic resonance venography, MIP - maximum intensity projection
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F1
A non-contrast brain CT scan in the ER showed SAH in paramedian sulci bilaterally more over the left fronto-parietal region (Figure 1A). Figure 1B) as well as transverse and sigmoid sinuses in (maximum intensity projection [MIP] anterior oblique view, Figure 1C). Fluid-attenuated inversion recovery (FLAIR) images showed the areas of hyperintensity bilaterally in frontal and parietal regions consistent with venous infarcts (Figure 1D).
PMC4727609_02
Non-contrast enhanced axial CT brain showing: A) bilateral SAH (arrow heads), predominantly over left fronto-parietal sulci (cSAH) surrounded by hypodense venous infarct (curved arrow). B) Thrombosis of SSS also visualized in sagittal and axial cuts, (straight arrows). C) MRV 3D MIP image, left lateral projection, showed SSS thrombosis (straight arrows), with non visualization of its tributaries. D) FLAIR axial images demonstrate hyperacute SAH as hyperintense curvilinear signals in bilateral frontal lobes, (straight arrows), and hyperintense signals in frontal cortex consistent with venous infarct (curved arrow). SAH - spontaneous subarachnoid hemorrhage, cSAH - convexity SAH, SSS - superior sagittal sinus, MRV - magnetic resonance venography, MIP - maximum intensity projection
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F2
SSS was evident (Figure 2A). Sagittal CT scan brain without contrast showed thrombosis of whole SSS (Figure 2B). The MRV showed SSS thrombosis with non-visualization of its tributaries (Figure 2C). There were hyperintense signals in frontal cortex consistent with venous infarct (Figure 2D).