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24 year-old female withheadache.

Most common clinical presentation is HA

Nausea, vomiting, seizures, focal deficits

Etiologies:

Local/systemic infection

Coagulopathies (pregnancy, OCPs, collagen vascular diseases)

Dehydration

25% cases remain idiopathic.

Can lead to venous ischemia or infarction

Grading of venous ischemia:

I: no MR abnormality

II: T2/FLAIR abnormality, no enhancement

III: T2/FLAIR abnormality with enhancement

IV: Hemorrhage or venous infarction.

CT

Hyperdense sinus/cortical vein

“Delta” sign with contrast – contrast surrounding intraluminal thrombus

MR

Clot of variable signal dependent upon age – hyperintense on T1 and T2 when subacute

Venous infarct – T2 hyperintense, petechial hemorr, +/- enhancement

Variable diffusion restriction.

Treatment

Heparin +/- TPA

Endovascular thrombolysis.