We present a case of dural sinus malformation with thrombosis of the right lateral sinus and venous infarction of the adjacent brain parenchyma.
Based on ultrasound, our first hypothesis was intracranial teratoma, with major mass effect and hydrocephaly. There was cardiomegaly secondary to vascular steal syndrome with mild pleural effusion and mild ascites.
MRI was performed and revealed:
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A thin line of cerebrospinal fluid best seen in coronal view next to the frontal right lobe and parietal right lobe, separating the mass from the brain parenchyma itself : most likely an extra axial mass.
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Intra axial brain damage as well on the adjacent cortex.
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The mass mainly showed hemorraghic signal, with characteristic black hypointense signal on T2* images. The mixed signal in T1 images, and also fluid-fluid levels on all sequences suggested continuous hemorrhage since the blood signal varies according to its age.
Our final diagnosis was dural sinus malformation with thrombosis, of the right lateral sinus in this case, with venous infarction of the adjacent brain parenchyma. The major mass effect, brain damage, and associated signs of cardiac failure bore a poor prognosis. There was therefore very little hope for spontaneous regression without sequelae.
The parents opted for normal delivery at 38 weeks gestation. The newborn passed away 2 days after delivery and autopsy was denied.
References
[1] Andreeva E. "Dural sinus thrombosis." TheFetus.net. https://thefetus.net/content/dural-sinus-thrombosis. Publish Date 7/2017.
[2] Ha N. "Dural sinus thrombosis." TheFetus.net. https://thefetus.net/content/dural-sinus-thrombosis-1. Publish Date 8/2017.
[3] Laurichesse Delmas H, Winer N, Gallot D, et al. Prenatal diagnosis of thrombosis of the dural sinuses: report of six cases, review of the literature and suggested management. Ultrasound Obstet Gynecol. 2008 Aug;32(2):188-98.