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QUESTION1. PRESENTATION: 33yr old lady with severe headache, fever & left sided weakness.2. BACKGROUND: Delivered healthy child 1 week prior. 3. O/E: drowsy, B/L papilloedema, right 6th nerve palsy, mild right hemiparesis. 4. INX: non-contrast CTB showed no abnormalities.

Neurology

QUESTION1. PRESENTATION: 33yr old lady with severe headache, fever & left sided weakness.2. BACKGROUND: Delivered healthy child 1 week prior. 3. O/E: drowsy, B/L papilloedema, right 6th nerve palsy, mild right hemiparesis. 4. INX: non-contrast CTB showed no abnormalities.

1. ANSWER: Cerebral venous sinus thrombosis

2. EXPLANATION:
- Non-contrast CT, when not associated with venous haemorrhage or infarction can show subtle findings, relying on hyperdensity of the sinus being identified .
- Thrombus can appear as a hyperdense vein or sinus for the first 7-14 days; this is an accurate sign when present.
- With contrast administration, especially with a CT venogram, a filling defect in a sinus is sought.
- Defect in the sagittal sinus is referred to as the 'empty delta sign'.
- CTV has a reported sensitivity of 95% compared to DSA as the gold standard.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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