50 year old man with sudden onset severe headache from 5 days. No focal deficits. Diagnosis and management?



There is sulcal SAH in parietooccipital regions seen as black in gradient images. Superior sagittal sinus is narrow and irregular on MRV. MRA doesn't show obvious aneurysm. In aneurysmal bleed Sylvian fissure n perimesencephalic region are usually involved. Hence it is a case of sulcal SAH (subarachnoid hemorrhage) secondary to CVT (cerebral venous thrombosis). I have started the patient on Mannitol and heparin, he is better, headache has reduced.

Yeah,, very interesting case,, bilateral sulcal SAH

right occipital small avm.?cant see any othrr problem.

nice to see the case discussion. I am interventional Neuroradiologist. we encounter such patients for in situ thrombolysis. just wanted to make one comment, the gradient images show thrombosed cortical veins and they cause confusion with Subarachnoid hemorrhage.. this is CVT. Anticoagulation is the mainstay of tt.

if.possible Praddep sir, pl do repost with marking!

Possibly cerebral venous thrombosis as delta sign in CT . However MRI- Venogram needed for confirmation. Treatment: LMW , Analgesic

I Thing increasing intracranial pressure with cerebral oedema And it's Due to Hypertensive Opthalmopathy !.....

Lesion in rt wernick region consult neurologist

Gradient images showing sulcal SAH

MRV showing filling defects

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