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Resident and Fellow Section

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1 Resident and Fellow Section
Imaging of occipital and falcine sinuses in an adult woman. Teaching NeuroImages Neurology Resident and Fellow Section © 2016 American Academy of Neurology Vollono et al.

2 Vignette A 42-years-old woman, affected by refractory headache since 4 weeks, referred to Emergency room. Neurological examination was negative. CT venography showed ecstasies of cortical veins, including the falcine and the occipital sinus. CT venography and MRI demonstrated occlusion of the sagittal, rectus and right sigmoidal sinus, of the right jugular vein. © 2016 American Academy of Neurology Vollono et al.

3 Imaging Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) in chronic sinus thrombosis. Occipital sinus is visible in T1-weighted, contrast enhanced MR angiography (A, arrow) and in CT-venography (B, arrow). Falcine sinus is visible in coronal T1-weighted, contrast enhanced MR angiography (C, arrow) and in CT-venography (D, arrow). © 2016 American Academy of Neurology Vollono et al.

4 Patency of falcine and occipital sinuses caused by chronic cerebral venous thrombosis
The falcine sinus usually involutes after birth1,2. The occipital sinus pericranii is the smallest dural venous sinus3. In our patient, the simultaneous patency of these alternative venous drainages is consistent with a compensatory mechanism for chronic dural sinus thrombosis. References 1. Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics : a review publication of the Radiological Society of North America, Inc 2006;26 Suppl 1:S19-41; discussion S42-13. 2. Lee I, Leach J, Tomsick T, Flaherty ML. Pearls & Oy-sters: Cerebral venous sinus thrombosis involving a persistent falcine sinus. Neurology 2015;85:e 3. Frassanito P, Massimi L, Tamburrini G, Caldarelli M, Pedicelli A, Di Rocco C. Occipital sinus pericranii superseding both jugular veins: description of two rare pediatric cases. Neurosurgery 2013;72:E ; dicussion 1058. © 2016 American Academy of Neurology Vollono et al.

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