Chronic Headache with MRI Findings Suggestive of Cerebral Venous Sinus Thrombosis

Case at a Glance

A 33-year-old male presented with chronic headaches and positional characteristics. MRI imaging revealed absence of flow void in the left transverse and sigmoid sinuses, raising concern for chronic venous sinus thrombosis.

Patient's Story

The patient experienced chronic headaches with positional components that prompted neuroimaging evaluation. Following the MRI scan, he reported significant improvement in his headache symptoms over the subsequent weeks.

Initial Assessment

Clinical evaluation revealed chronic headaches with red flag features including positional characteristics. The patient met criteria for urgent neuroimaging based on clinical decision support scoring. Physical examination and initial workup led to MRI brain imaging to rule out intracranial pathology.

The Diagnostic Journey

MRI of the head demonstrated absence of flow void in the left transverse and sigmoid sinuses extending to the internal jugular vein. The brain parenchyma, ventricles, orbits, and paranasal sinuses appeared normal with no other intracranial abnormalities identified. The radiologist recommended further evaluation with CT venography to better characterize the venous anatomy.

Final Diagnosis

Suspected left transverse and sigmoid sinus chronic thrombosis based on MRI findings. The absence of normal flow void signal in these venous structures raised concern for chronic cerebral venous sinus thrombosis, though confirmatory imaging was recommended.

Treatment Plan

Urgent follow-up imaging with intracranial CT venogram was recommended to confirm the diagnosis. Depending on confirmatory results, anticoagulation therapy would likely be initiated. Patient counseled on the importance of prompt follow-up given the potential for serious complications if venous thrombosis is confirmed.

Outcome and Follow-up

Patient experienced spontaneous improvement in headache symptoms following initial imaging. However, given the concerning MRI findings and 4-week delay in result communication, urgent subspecialty consultation and confirmatory imaging were prioritized to rule out cerebral venous sinus thrombosis and initiate appropriate treatment if confirmed.