Cerebral venous thrombosis of the sphenoidal sinus with hemorrhagic transformation

초록

Purpose : Several variation of the cortical venous anatomy makes thrombosis involving these cortical vessels difficult to diagnose radiologically. Due to the limited case number of cortical venous thrombosis, the clinical manifestation and the outcome of cortical venous thrombosis remained unclear. Methods : We report the case of a 41year old women, who presented to the Neurology department with ongoing and intractable headaches, and nausea. Results :Routine Brain MR images showed ill, non-enhancing lesion with low signal intensities(SI) on Gradient echo images,in left anterior temporal pole. Further digital subtraction images showed venous congestion of left anterior temporal area and nonvisualization of left cortical sphenoid sinus. Initial diagnosis for this lesion included the vasculitis, cerebral venous thrombosis and tumor. For navigation of brain biopsy, we checked high resolution MR scans, which showed the thrombosed sphenoidal sinus. The laboratory findings indicated the severe iron-deficiency anemia. After the 2 months of oral anticoagulation, the headache improved and follow-up MR images revealed that lesion with partial resolution of the thrombus. Conclusions :The venous infarction related to thrombosed cortical sphenoidal sinus is a rare clinical finding. If diagnosed early and treated properly, outcomes seem favorable. If the patients with unexplained edema in the anterior temporal area, venous thrombosis of sphenoidal sinus might be ruled out.