Sthanu Subramanian: CVST as The ‘Great Masquerader’ with Normal Initial CT
Sthanu Subramanian, Pediatrician, shared Sudhir Kumar’s post on X:
“Cerebral Venous Sinus Thrombosis (CVST) is indeed a ‘great masquerader’ in neurology, and while non-contrast computed tomography (NCCT) is often the first-line imaging study due to its availability, it can be falsely reassuring.
NCCT may be normal in up to 30% of cases, particularly in the early or subacute stages.”
Sudhir Kumar, Neurologist at Apollo Hospitals, shared a post on X:
“(For doctors- Neurology Case Discussion)
CT Brain is normal… but something is clearly wrong.
- A 37-year-old man presented with 1-month headache (mostly right-sided)
- Headache occurs daily, associated with recurrent vomiting
- No history of fever
- One week back: CT brain and CSF analysis done elsewhere: Normal
- Referred to me for second opinion.
What is the likely diagnosis?
A) Migraine
B) Idiopathic intracranial hypertension
C) Cerebral venous sinus thrombosis
D) Viral encephalitis
MRI FLAIR and MRI Venogram pictures are attached.
What are the findings?
Key clues:
- Subacute progressive headache
- Signs of raised ICP (vomiting)
- Normal CT (don’t be reassured!)
- MRV is the game-changer
Answer:
C) Cerebral venous sinus thrombosis
- MR Venogram shows Non-visualization of a major venous sinus, along with collateral venous channels
- MRI brain may be normal early; don’t miss this.
Teaching pearl:
‘Normal CT scan with persistent headache and vomiting means Think of CVST and Do MRV.’
Miss this, and the consequences can be devastating.”
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