Giant Superior Sagittal Sinus Thrombosis with Persistent Falcine Sinus

A 55-year-old woman presented with a headache for one year. Magnetic resonance venogram (MRV) showed persistent falcine sinus (PFS) and filling defect in the superior sagittal sinus (SSS) [Figure 1a]. T2-weighted imaging showed deoxyhemoglobin or hemosiderin-related hypointensity simulated flow void in SSS, but the signal was inhomogeneous and the corresponding area was enlarged [Figure 1b]. The abnormal signal in the SSS, coupled with the absence of flow on MRV, confirmed the diagnosis of cerebral venous sinus thrombosis (CVST). Three years later the patient was admitted to our hospital again due to 10 days of worsening headache and blurred vision, physical examination showed bilateral papilloedema. MRV showed the filling defect in enlarged SSS and PFS was compressed and displaced forward [Figure 1c]. Sagittal T1 postcontrast showed inhomogeneous masses in SSS [Figure 1d]. Laboratory evaluation revealed the following: D-Dimer, 0.7 mg/L; plasma prothrombin time, 10.1 s; prothrombin activity, 101.5%; international normalized ratio, 0.85; and activated partial thromboplastin time, 26.2 s. Due to the large size of the masses, the patient underwent surgical resection treatment. Postoperative pathology revealed mixed-thickness vascular hyperplasia, fibrous proliferation, and mixed inflammatory cell infiltration. During 5 months of follow-up after resection, the patient was feeling well.Figure 1: (a, b) Initial magnetic resonance imaging. (a) MRV shows PFS (arrow) and a filling defect in the posterior part of SSS. (b) Sagittal T2WI shows deoxyhemoglobin or hemosiderin-related hypointensity simulated flow void in SSS, but the signal is inhomogeneous and the corresponding area is enlarged (arrows). (c, d) Magnetic resonance imaging after 3-year follow-up. (c) MRV shows an enlargement of the filling defect area in SSS, with PFS compression and forward displacement (arrow). (d) Sagittal T1 postcontrast shows dilation of the posterior part of SSS with inhomogeneous masses (arrows). MRV = Magnetic resonance venogram, PFS = persistent falcine sinus, SSS = superior sagittal sinus, and T2WI = T2-weighted imagingPFS may be an isolated anatomical variation or be caused by CVST.[1,2] When CVST forms, especially in the posterior part of SSS, the opening of the falcine sinus can provide an alternative pathway for venous drainage, thereby reducing intracranial hypertension, and delaying or avoiding the occurrence of cerebral vasogenic edema or venous infarction.[3] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.