Imaging of persistent bilateral occipital sinus with absent bilateral transverse sinus

Persistent occipital sinus with absent/ hypoplastic bilateral transverse sinus is an extremely rare finding in adults; less than 10 cases have been reported. We present a case of a 28-year-old male who was brought to the emergency department in a post-ictal state associated with blurring of vision and 1 vomiting episode. Magnetic resonance imaging (MRI) with angiography and venography of the brain was advised, and the brain parenchyma was found to be anatomically normal. Incidental findings of the persistent occipital sinus with absent/ hypoplastic bilateral transverse sinus were made using venography imaging of the brain. This is a type of fetal presentation of venous blood flow. It is paramount to neurosurgeons because a prominent occipital sinus with an absent bilateral transverse sinus might change the surgical approach for the posterior fossa lesions.