Pediatric Dural Venous Sinus Thrombosis

  • Etiology:
    — Risk factors are hypercoaguability, contraceptives, dehydration, collagen vascular disease, lumbar puncture, mastoiditis, temporal or occipital bone fracture, meningitis
    — Neonatal superior sagittal sinus thrombis is associated with maternal and perinatal and neonatal risk factors
    — Cortical vein thrombosis can lead to dural venous sinus thrombosis – thrombus forms central to peripheral and deep dural sinus thrombosis gets bithalamic edema and hemorrhage
  • Imaging CT:
    — CT without contrast: Hyperdense expanded dural venous sinus = cord sign which is hyperdense cord or clot along expanded and thrombosed dural sinus
    — CT with contrast: Empty delta sign
  • Imaging MRI:
    — T1WI: Hyperintense thrombus in superior sagittal sinus
    — T1WI post contrast: Empty delta sign
  • DDX:
    — Neonates have normally high hematocrit making vessels, especially venous sinuses, look dense
    — Hyperdense blood in all dural venous sinuses can be seen in setting of increased hematocrit, polycythemia vera, dehydration, diffuse thrombus
  • Complications in neonate:
    — Venous infarction within region of brain that drains into sinus
    — Involves thalami in medullary vein and straight sinus and Vein of Galen thrombosis
    — Involves cortex and subcortical white matter with sagittal sinus thrombosis
    — Infarction characteristically bilateral and hemorrhagic typically involving the cortex and subcortical white matter
  • Treatment:
  • Clinical:
    — Most common cause of hemorrhagic stroke in children

Radiology Cases of Dural Venous Sinus Thrombosis

Radiology Cases of Dural Venous Sinus Thrombosis of the Sigmoid Sinus

CT of mastoiditis with dural venous sinus thrombosis
Axial CT with contrast of the brain with bone windows (left) shows complete opacification of the mastoid air cells bilaterally. MRV with contrast of the brain (right) shows a lack of venous flow in the right sigmoid sinus.

Radiology Cases of Dural Venous Sinus Thrombosis of the Superior Sagittal Sinus

US CT MRI of superior sagittal sinus thrombosis / SSST
Coronal spectral (upper left) and color (upper right) doppler US of the superior sagittal sinus shows decreased flow within it. Axial CT without contrast of the brain (below left) shows increased density in the superior sagittal sinus. Sagittal T1 MRI without contrast of the brain (below right) shows focal areas of increased signal intensity in the superior sagittal sinus.