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Images in Neurology |

Cerebral Straight Sinus Thrombosis An Unusual Cause of Confusion

Meital Ben-Dov, MD1; Edna Inbar, MD2; Israel Steiner, MD, FRCP1
[+] Author Affiliations
1Department of Neurology, Rabin Medical Center, Petach Tikva, Israel
2Section of Neuroradiology, Department of Neurology, Rabin Medical Center, Petach Tikva, Israel.
JAMA Neurol. 2015;72(12):1527. doi:10.1001/jamaneurol.2015.2282.
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This case report describes a man with confusion and somnolence who had massive infarcts with episodes of bleeding into the thalami and basal ganglia consistent with a filling defect extending throughout the patient’s straight sinus.

A man in his mid-60s with atrial fibrillation who was being treated with warfarin sodium presented with 3 days of confusion and somnolence. His international normalized ratio was 2.07. There was no evidence of infection or metabolic abnormality. His cerebrospinal fluid had an opening pressure of 26 cm H2O and normal contents. The patient’s confusion progressed and both magnetic resonance imaging and computed tomographic venography demonstrated massive infarcts with episodes of bleeding into the thalami and basal ganglia consistent with a filling defect extending throughout the patient’s straight sinus (Figure). Full anticoagulation therapy was begun, but the patient died after 3 days of hospitalization.

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Figure.
Dural Straight Sinus Thrombosis and Bilateral Deep Hemispheric Infarction

A, Susceptibility weighted imaging (SWI) with episodes of bleeding in the thalami bilaterally and in the left basal ganglia. B, Axial section on fluid-attenuated inversion recovery (FLAIR) and magnetic resonance imaging demonstrates high signal intensity and swelling of the thalami, basal ganglia, and internal capsules on both the left and right, and splenium of the corpus callosum. C, Sagittal reconstruction of computed tomographic venography (CTV) imaging shows filling defects in the straight sinus, vein of Galen, and distal inferior sagittal sinus (arrowheads).

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