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Images in Neurology |

An Unusual Case of Chronic Dural Thrombosis

Fabio Pilato, MD; Simona Gaudino, MD; Paolo Profice, MD; Giacomo Della Marca, MD; Cesare Colosimo, MD; Vincenzo Di Lazzaro, MD
Arch Neurol. 2010;67(9):1148-1149. doi:10.1001/archneurol.2010.212.
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A 43-year-old man presented in the emergency department with intense headache, vomiting, transitory disorientation, and language impairment. He complained of chronic headache and he had history of Wegener granulomatosis with pulmonary involvement. The diagnosis of Wegener granulomatosis was made 5 years before from a biopsy specimen of a pulmonary mass. Computed tomographic scan was performed and showed a bilateral hemispheric edema and calcification along the meninges with no sign of hemorrhage (Figure, A). Magnetic resonance imaging performed to evaluate the cerebral sinus showed dural calcification, occlusion of the sagittal and rectus sinus, and ectasia of cortical veins (Figure, B and C) consistent with venous sinus thrombosis. Magnetic resonance imaging 3-dimensional maximum intensity projections (Figure, D and E) better revealed cortical vein abnormalities with pronounced ectasia, consistent with chronic sinus thrombosis.

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Computed tomography and magnetic resonance imaging. A, Cranial computed tomographic images demonstrate falx and dural calcifications (arrows) and hyperdensity of the tentorium (arrowheads). B, Axial fast-spin echo T2-weighted image shows a marked hypointensity of the cerebral falx related to the calcifications (arrow) and hypointensity of the tentorium related to the thickening and fibrosis of the tentorial dura mater (arrowheads). C, Sagittal projection of a 3-dimensional, spoiled gradient, contrast-enhanced magnetic resonance angiography demonstrates the superior sagittal (open arrows) and straight sinus (double arrows) occluded. D and E, Three-dimensional maximum intensity projections better reveal cortical vein ectasia consistent with chronic sinus thrombosis.

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