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A 22-year-old woman with 4-month history of immature ovarian teratoma presents with acute tonic-clonic seizure.

What is your diagnosis?

A. Cerebral venous sinus thrombosis

B. Hemorrhagic infarcts

C. Primary lobar hemorrhage

D. Hemorrhagic intracranial metastases

A

B

C

?

?

?

The answer is Cerebral Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVST) is an uncommon and potentially devastating disease.
Patients with CVST typically present with pseudotumor cerebri-like headache.
The causes of CVST are numerous, including dehydration, hypercoagulable states, infection, and use of oral contraceptive.
The thrombosed dural sinus (A and C, orange arrows) causes vasogenic and, later on, cytotoxic edema (A and B, white arrows), which may lead to parenchymal hemorrhage (B, yellow arrows).
Venous infarct may cross normal arterial vascular territories, and the region of infarct can be predicted by the venous drainage territories.
Acute-subacute occlusion of the dominant transverse sinus can result in significant cerebral edema over the posterior temporal and parietal lobes (A and B, white arrows) and subsequent hemorrhage (B, yellow arrows).
The thrombosed sinus may show “dense clot sign” in noncontrast CT (B, yellow arrows).
Top differentials include anatomic variants, giant arachnoid granulation, and high hematocrit, among others.

中文版：

女性，22歲，發(fā)現(xiàn)卵巢不成熟畸胎瘤4月，突發(fā)強直性癲癇發(fā)作

診斷？

A. 靜脈竇血栓形成

B. 出血性梗死

C. 原發(fā)性腦葉出血

D. 出血性腦轉移

診斷：靜脈竇血栓形成

靜脈竇血栓形成（CVST）是一種少見、具有潛在致死性的疾病。
患者典型臨床表現(xiàn)為腦腫瘤樣疼痛。
CVST的病因很多，包括脫水、高凝狀態(tài)、感染以及使用口服避孕藥。
靜脈竇血栓（A,C橙色箭頭）可引起血管源性水腫，隨后出現(xiàn)細胞毒性水腫（A,B白箭頭），并引起腦實質出血（B黃色箭頭）。
靜脈性腦梗死可跨腦動脈供血區(qū)，梗死區(qū)域符合靜脈引流區(qū)域。
橫竇急性-亞急性閉塞可引起顳葉后部和頂葉嚴重腦水腫（A,B白箭頭），并可繼發(fā)出血（B黃箭頭）。
靜脈竇血栓于CT平掃表現(xiàn)為“密集血塊征”。
鑒別診斷包括解剖變異、巨大蛛網(wǎng)膜顆粒以及高血細胞比容。

From ajnr classic case