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Abstract
Cerebral venous thrombosis [CVT] ranges in the population from an overall adult incidence of 1.32 per 1 00 000 population, with an annual incidence higher in women than men.1 Often CVT symptoms can present with comorbid headache [HA] and severe pain in isolation of other signs and symptoms, which further substantiates the necessity of addressing a robust differential for HA and a quick response with treatment. Furthermore, use of balloon intravascular thrombectomy has been considered in some cases of CVT, however evidence based outcomes comparing best medical practices versus emergent endovascular treatment is limited to case studies and anecdotical clinical judgment. Accordingly, this case reflects upon the unusual slow and insidious presentation of HA, despite severe CVT and an otherwise uncommon subarachnoid hemorrhage [SAH], as well as the successful emergent delivery of a relatively novel endovascular treatment.
Non-contrast MRV head showing complete venous occlusion and no flow of the superier sinus, straight sinus, and bilateral tranverse sinuses.
Non-contrast MRI Brain, T2, T1, and DWI sequences from left to right and below showing promonent venous sinus thrombus seen in the straight sinsus and confluences of sinuses.
Non-contrast CT Brain showing delta sign and subarachonid hemorrhage surrounding the straight sinus.
Disclosures A. Alvarado-Ortiz: None. M. Evans: None. J. Nazar: None. R. Kaushal: None.