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LETTER TO THE EDITOR
Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 59

Cerebral venous sinus thrombosis with nontraumatic subdural hematoma


1 Department of Radiodiagnosis, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
2 Department of Neurosurgery, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
3 Department of Neurology, Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India

Date of Web Publication2-Mar-2015

Correspondence Address:
Ranjan Kumar Sahoo
Department of Radiodiagnosis, Institute of Medical Science and SUM Hospital, Sector 8, Kalinga Nagar, Ghatikia Bhubaneswar - 751 003, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5151.152348

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How to cite this article:
Sahoo RK, Tripathy P, Praharaj H N. Cerebral venous sinus thrombosis with nontraumatic subdural hematoma. Int J Crit Illn Inj Sci 2015;5:59

How to cite this URL:
Sahoo RK, Tripathy P, Praharaj H N. Cerebral venous sinus thrombosis with nontraumatic subdural hematoma. Int J Crit Illn Inj Sci [serial online] 2015 [cited 2018 May 25];5:59. Available from: http://www.ijciis.org/text.asp?2015/5/1/59/152348

Dear Editor,

A 60-year-old-patient reported to our hospital with complaints of acute onset of weakness over right side limbs for 2 days and complex partial seizure for 1 day. He was a known diabetic and hypertensive under irregular medication with no history of recent trauma. He had grade-III power in right side limbs, right side extensor plantar reflex, and bilateral papilledema. Noncontrast computed tomography (NCCT) scan of head shows thin isodense (subacute) subdural hematoma (SDH) over left frontal lobe convexity [Figure 1]. Contrast-enhanced magnetic resonance imaging (MRI) of brain shows T1W iso to hyperintense, T2W hypointense thin collection over left frontal lobe convexity and occluding thrombus in right transverse, sigmoid sinus and part of superior sagittal sinus. The patient was treated with antidiabetic, antihypertensive drugs and low molecular weight heparin, followed by oral warfarin with maintenance of the prothrombin time, international normalized ratio (prothrombin time INR) at 2:1. The patient recovered well on treatment.
Figure 1: Non-contrast computed tomography of head (a and b) shows thin subacute subdural hematoma over left frontal lobe convexity which is iso to hyperintense in T1W(d) and hypointense in T2W(e) image. Contrast-enhanced magnetic resonance image of head shows thrombus(arrow mark) of sagittal sinus(c) and right sigmoid sinus(f)

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Cerebral venous sinus thrombosis (CVST) accounts 1%−2% of strokes in adult. [1] Trauma, infection, pregnancy, hormonal therapy, surgery, hypercoagulable disorders, connective tissue disease, malignancy, dehydration, tumor, diabetes mellitus, and nephrotic syndrome are common etiological factors. [2] The SDH is possibly due to rupture of bridging veins resulted from high backpressure by the obstructed thrombosed vein. [3] While NCCT scan of head is ideal for evaluation of intracranial hemorrhage, MRI with magnetic resonance venography is the investigation of choice for CVST. Small SDH with CVST can be managed conservatively by anticoagulants.

 
   References Top

1.
Leach JL, Strub WM, Gaskill-Shipley MF. Cerebral venous thrombus signal intensity and susceptibility effects on gradient recalled-echo MR imaging. AJNR Am J Neuroradiol 2007;28:940-5.  Back to cited text no. 1
    
2.
Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: Current techniques, spectrum of findings, and diagnostic pitfalls. Radiographic 2006;26:S19-43.  Back to cited text no. 2
    
3.
Mathew T, Sarma GR, Kamath V, Roy AK. Subdural hematoma, subarachnoid hemorrhage and intracerebral parenchymal hemorrhage secondary to cerebral sinovenous thrombosis: A rare combination. Neurol India 2007;55:438-9.  Back to cited text no. 3
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