Woman in her 30s with medical history of occasional migraine | Figure 1

DKIrad

Radiology

Woman in her 30s with medical history of occasional migraines presents to outside hospital with seizure and loss of consciousness. Only medication is Depo-Provera. Head CT without contrast was done then she was transferred to our institution. A CT of the head without contrast was repeated on arrival as shown above. What is the differential diagnosis and next steps for diagnosis?

Similar cases

Axial non-contrast head CT (images 1 and 2) show a hyperdense clot (arrow) within the posterior aspect of the superior sagittal sinus and ischemic changes (arrowhead) within the anterolateral right frontal lobe, confirmed at a higher level on image 2. Contrast-enhanced images from a CT venogram (images 3 and 4) emphasize the filling defect (arrow) within the superior sagittal sinus. At the level of the torcula (image 4), the clot creates the 'empty delta' sign. This sign is indicative of superior sagittal sinus thrombosis, where contrast outlines the thrombus on a CT venogram. Such thrombosis can result from trauma, infection, or hypercoagulable states.

Cor and Sag head CT in a preschooler with headaches shows heterogeneously increased attenuation and expansion of the superior sagittal sinus, concerning for thrombus. Note the length of nonocclusive thrombus in the SSS. Cerebral venous thrombosis can be due to a variety of local and systemic causes. #NeuroWednesday

Sagittal postcontrast CT image child with a closed head injury shows injury to the anterior portion of the superior sagittal sinus with extravasation of contrast (arrow) into the extracranial soft tissues and partial thrombus (arrowhead) of the anterior aspect of the superior sagittal sinus. The most common site of dural venous sinus injury is the anterior and middle third of the superior sagittal sinus. Because of the rich collateral venous drainage at this location, patients can be treated with sinus ligation. #NeuroWednesday

Tingling sensation sometimes combined with pain.
A 21 years old man complains from tingling pain in his right hand, right foot, uncomfortable sensation on his right side of the thorax skin and daily pain of right side of his head. This sensation every day is present and increases so much when slight pressure is applied.
Before two days the pain attacks his teeth is moving from one to other from left side to right side and so on.
The tingling sensation sometimes moves to his left hand and left foot.
Hint:- This tingling is combined with burning sensation.
Urine analysis contains urates and calcium oxalate crystals.
In MRI:
I seen an elevation in the middle of the brain what's that?
And what's the diagnosis for this case?
What's the treatment?
Any diagnostic test needed to this case?