Blood-fluid level in cortical venous thrombosis--a rare diagnostic entity

With improvement in imaging, CVT is being diagnosed more frequently. Early diagnosis and rapid institution of remedial measures such as anticoagulation, anticonvulsants, hydration, and treatment of underlying abnormality will aid in salvaging life.

We report an autopsy case of a 34-year-old man who presented with sudden onset of seizures, followed by right hemiplegia and altered sensorium. Magnetic resonance imaging of the brain revealed intraparenchymal hemorrhage in the left posterior frontal region with a blood-fluid level. The SSS was devoid of the routine hypointense signal intensity. Routine evaluations for hypercoagulable states were negative. All the coagulation parameters were within normal limits. He was managed conservatively with anticonvulsants, anticoagulants, and hydration. A CT scan of the brain done 24 hours later revealed left posterior frontal hemorrhage with perilesional edema. A CT venogram confirmed the presence of CVT involving the SSS and the right transverse sinus. However he died within next 24 hours. An autopsy confirmed thrombosis in the SSS, right transverse sinus, lungs, and kidneys.

Blood-fluid level in CVT may be an early radiologic sign in the absence of any other imaging abnormality. The presence of this sign in the early stages warrants an aggressive treatment because this probably suggests a large bleed with raised capillary and venous pressures. The case is discussed in view of the unusual radiologic sign in CVT in the absence of anticoagulant therapy.