Subarachnoid hemorrhage as the initial presentation of dural sinus thrombosis.
Cerebral venous thrombosis (CVT) can be difficult to diagnose because of its wide spectrum of clinical manifestations. Its diagnosis may be further complicated when patients initially present with acute subarachnoid hemorrhage (SAH). We report on four patients with SAH revealing a CVT and discuss the role of imaging for diagnostic and pretherapeutic workup. In three women and one man presenting with severe headaches, images initially suggested SAH with no associated parenchymal bleeding. In all patients, SAH involved the sulci of the convexity and spared the basal cisterns. Digital subtracted angiography showed occlusion of intracranial venous sinuses but did not reveal any other cause of SAH. All patients improved with anticoagulant therapy. Risk factors for CVT and SAH, namely, head trauma and oral contraception, were identified in two patients. These cases highlight the fact SAH may reveal a CVT, which should be considered in the diagnostic workup of SAH, especially when the basal cisterns are not involved.
Oppenheim
Catherine
C
Department of Neuroradiology Sainte-Anne Hospital, Paris V University.
Domigo
Valérie
V
Gauvrit
Jean-Yves
JY
Lamy
Catherine
C
Mackowiak-Cordoliani
Marie-Anne
MA
Pruvo
Jean-Pierre
JP
Méder
Jean-François
JF
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D004388:Dura Mater / Q000098:blood supply*; D017352:Echo-Planar Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012851:Sinus Thrombosis, Intracranial / Q000150:complications* / Q000188:drug therapy; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology*
D000925:Anticoagulants