Images in Clinical Medicine

Cerebral Venous Thrombosis

Amir Jaffer, M.D., and Dana Leifer, M.D.

N Engl J Med 1997; 337:395August 7, 1997

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Article

Figure 1 An 18-year-old woman presented three weeks post partum with a one-week history of headaches and two days of nausea, vomiting, and photophobia. On examination she was drowsy and had bilateral papilledema and a mild palsy of the right abducent nerve. A computed tomographic scan of the head was normal. Lumbar puncture revealed an opening pressure of 42 cm of water. A T₁-weighted magnetic resonance image (Panel A) revealed high signal intensity in the straight sinus and the vein of Galen, findings compatible with thrombus (arrowheads). Magnetic resonance venography (Panel B) showed normal flow in the superior sagittal sinus, left sigmoid sinus, and left internal jugular vein (arrowheads). Irregular flow was seen in the left transverse sinus, a finding consistent with partial thrombus (arrow). No flow was visualized in the straight sinus, right transverse sinus, right sigmoid sinus, and right internal jugular vein. A diagnosis of cerebral venous thrombosis was made, and the patient was given heparin. She was discharged receiving warfarin. A few weeks later, she presented with recurrent headaches and papilledema; her international normalized ratio was subtherapeutic. Anticoagulant therapy was reinstituted, and her headaches resolved and

Amir Jaffer, M.D.
Dana Leifer, M.D.
Yale University School of Medicine, New Haven, CT 06520