Concluded Case

Cerebral sinus thrombosis with large parenchymal bleed rt temporoparie

New case 44 yr old Maldivian ,F,No Co- comorbidities developed acute onset of head ache with defective vision and left sided numbness about 10 days ago . Head ache was moderate in intensity with out any nausia/ vomiting / vertigo . An hr after the onset of head ache she noticed defective vision with left sided numbness.Evaluated at local hospital MRI done ,came for further management. On exam BP 130/ 70 mmhg ,left homonimous hemianopia with intact cranial nerves . Motor systemgr5/ 5 power with mild hyper reflexes Lt with flexor plantars. Dulling of all modalities of sensations left half of the body . Diagnosis ? Ct brain is also posted (lastFilm)

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Thanks Curofy and all Doctors who answered the case. MR Imaging findings are suggestive of multifocal cerebral venous sinus thrombosis with large hemorrhagic infection Rt posterior temporo parietal subcortical region. Pt was stated in Clexane 0.6 MLS twice daily for 5 days and then on warf. Currently warf 6 mg and current INR 2.6 .She is on other supportive med.Comlplete investigations for Cortical venous sinus thrombosis including fasting homocysteine were - ve MRI report : Images show an early subacute hemorrhagic infarction with parifocal edema & mass effect involving posterior temporal ,temporoparietal subcortical regions on RT side.Rt lateral ventricle is partially compressed.Supratentorial portion of rt ambian cistern is narrowed. MrV shows a segment of irregular luminal narrowing / filling defect in posterior part of Superior sagittal sinus Transverse,sigmoid sinus& IJV on left do not show any enhance ment.Abnormal venous collateral are seen posterior to upper part of IJV.
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Thanks Curofy and all Doctors who answered the case. MR Imaging findings are suggestive of multifocal cerebral venous sinus thrombosis with large hemorrhagic infection Rt posterior temporo parietal subcortical region. Pt was stated in Clexane 0.6 MLS twice daily for 5 days and then on warf. Currently warf 6 mg and current INR 2.6 .She is on other supportive med.Comlplete investigations for Cortical venous sinus thrombosis including fasting homocysteine were - ve MRI report : Images show an early subacute hemorrhagic infarction with parifocal edema & mass effect involving posterior temporal ,temporoparietal subcortical regions on RT side.Rt lateral ventricle is partially compressed.Supratentorial portion of rt ambian cistern is narrowed. MrV shows a segment of irregular luminal narrowing / filling defect in posterior part of Superior sagittal sinus Transverse,sigmoid sinus& IJV on left do not show any enhance ment.Abnormal venous collateral are seen posterior to upper part of IJV.
CT suggestive of ischaemic lesion. ME venogram — having dilated sinuses... s/o - Venous infarct. DD- meningioma of Rt. Occipital lobe.
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CT suggestive of ischaemic lesion. MR venogram — having dilated sinuses... s/o - Venous infarct. DD- meningioma of Rt. Occipital lobe.
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Occipital AVM,But angio,veno is giving picture of avm or sometimes dural,avf also like this but this looks more AVM.
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Rt parietooccipital hypodensity with some hyperdensity s/o ischemia with hemorrhagic transformation
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AVM with bleed. Need to be operated. Consult brain vascular surgeon.
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Can we go straight to warfain ignoring the bleed
There is Protocol / guidline to start anticoagulation in Cerebral sinus thrombosis. We are going accordingly.
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Meningioma right occipitoparietal lobe
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Meningioma rt. Occipitaloparietal lobe
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