Prof.Dr.Miodrag Vrcakovski

Brain herniation into the dural venous sinuses is a rare entity which can simulate sinus thrombosis.

In the vast majority of cases it is asymptomatic.
Sometimes, as in our case, it is associated with a headache and in certain occasions epilepsy.

We present a case of a 32 year old woman with a history of severe recurring headaches during the last two years. The headaches have been always occurring on the left side, starting mainly during the night and while sleeping.
Several times they were followed by a loss of consciousness for a period of 10 to 20 seconds.

The video below show you a sneak peek of what’s ahead:

During the first MRI examination of the brain done in another diagnostic center a large filling defect was detected in the left transverse sinus.
Filling defects were also seen into the right transverse sinus.
The conclusion of the radiologist was a clots caused by a Sinus Thrombosis . Anticoagulation therapy was started.

The follow-up MRI examination reveal a herniation of the left inferior temporal gyrus into the transverse dural sinus as a result of a giant arachnoid granulation protruding into the sinus. (Fig.1).


Fig. 1

Two larger arachoid granulations protruding into the right transverse sinus were also detected, but whitout brain herniation (Fig.2).


Fig. 2

In this case High Resolution 3D MRI sequences as well as the freehand applied reconstruction parameters were found most useful in establishing the precise diagnosis.

My Power Point presentation will help you to understand the scenario of this unusual phenomenon.
Three  additional bonus cases are included.

To download the whole presentation please proceed to the link below:

To get the whole presentation, proceed to the link below: