Neuro_CTA_Head/Neck: 57 F, basal ganglia hemorrhage.


CLINICAL HISTORY: Basal ganglia hemorrhage, rule-out sinus thrombosis. 


Non contrast CT of the head demonstrates acute hemorrhage centered within the right basal ganglia and thalamus. A small amount of intraventricular extension of hemorrhage is seen.  

There is mild to moderate hydrocephalus which may be a combination of communicating and non-communicating. The fourth ventricle is small, and there is slight crowding of the foramen magnum.  

Low density changes with mass effect are seen bilaterally (right greater than left) involving the basal ganglia and thalami. The left lentiform nucleus and caudate are spared. There is also evidence of generalized cerebral swelling with decreased size of sulci and basal cisterns noted. Gray-white matter differentiation along the convexities is maintained.

CTA performed from arch to circle of Willis demonstrates normal arterial structures. Three vessel arch anatomy is present. The carotid arteries and vertebral arteries are widely patent. No significant narrowing is seen.

Incidental note is made of fetal origin of the right posterior cerebral artery. The posterior circulation is otherwise unremarkable. The carotid arteries, middle cerebral arteries and anterior cerebral arteries bilaterally are patent.

The superior sagittal sinus is patent along its visualized course with presumed flow to a dominant large right transverse sinus. There is a partial filling defect within the lower right transverse sinus vs deviation from midline. The straight sinus does not opacify normally and appears almost completely thrombosed. The left transverse sinus is not well visualized and may be partially thrombosed. Distally, the left transverse sinus and sigmoid sinus are small and opacified. The left internal jugular vein within the jugular canal appears to have a filling defect and may have focal thrombus. Below the C2 level, however, the left internal jugular vein is widely patent.

Incidental note is made of a nasogastric tube which is coiled within the upper esophagus. As well, an endotracheal tube is present which may be in slightly low position. The tip of the endotracheal tube is not visualized but extends to at least the tracheal carina.

1. Evidence of bilateral deep venous infarcts with hemorrhage on the right and associated hydrocephalus either due to congestion or compression of the third ventricle as well as evidence of cerebral edema.
2. Straight sinus thrombosis with likely extension into the left transverse sinus. 
3. Possible focal thrombosis of the superior left internal jugular vein.

(Straight sinus thrombosis with hemorrhagic infarcts)

Accession: CL27388555

Study description: CT ANG Head/Nck