# June 2022

- Link: https://isnr.in/june-2022/
- Published: 2022-06-01T08:22:17+05:30
- Author: ISNR

##  June 2022

**CASE HISTORY**:

•Insidious onset of protrusion of right eyeball, which has increased over 1 month.

•History of trivial fall 8 months ago with no loss of consciousness.

**Neurological Examination**

•Right eye proptosis with prominent veins

•Right temporal bruit.

•No motor deficits. Power 5/5. Tone is normal.

## **Case contributed by –**

**• Dr. ****Abin**** Jose, Radiology, ****Manipal**** Hospitals, Bangalore.**

**• ****Dr.**** ****Ullas**** V ****Acharya**** , Radiology,  ****Manipal**** Hospitals,
Bangalore.**

| [⌊1June2022_1⌉](https://isnr.in/wp-content/uploads/2022/06/1June2022_1.jpg) | [⌊1June2022_2⌉](https://isnr.in/wp-content/uploads/2022/06/1June2022_2.jpg) | [⌊1June2022_3⌉](https://isnr.in/wp-content/uploads/2022/06/1June2022_3.jpg) | [⌊1June2022_4⌉](https://isnr.in/wp-content/uploads/2022/06/1June2022_4.jpg) | 
| [⌊1June2022_5⌉](https://isnr.in/wp-content/uploads/2022/06/1June2022_5.jpg) | [⌊1June2022_6⌉](https://isnr.in/wp-content/uploads/2022/06/1June2022_6.jpg) | [⌊1June2022_7⌉](https://isnr.in/wp-content/uploads/2022/06/1June2022_7.jpg) | [⌊1June2022_8⌉](https://isnr.in/wp-content/uploads/2022/06/1June2022_8.jpg) |

| [](https://isnr.in/wp-content/uploads/2022/06/June15_A.jpg) | [](https://isnr.in/wp-content/uploads/2022/06/June15_B.jpg) | [](https://isnr.in/wp-content/uploads/2022/06/June15_C.jpg) | [](https://isnr.in/wp-content/uploads/2022/06/June15_D.jpg) | 
| [](https://isnr.in/wp-content/uploads/2022/06/June15_E.jpg) | [](https://isnr.in/wp-content/uploads/2022/06/June15_F.jpg) | [](https://isnr.in/wp-content/uploads/2022/06/June15_G.jpg) | [](https://isnr.in/wp-content/uploads/2022/06/June15_H.jpg) | 
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**Legends**

•**A)Coronal T2W  **shows massively dilated proximal left transverse sinus possibly
involving Torcula, suggestive of dural sinus malformation.

•**B)Axial T1 PC** shows contrast enhancement of the dural sinus malformation. No
evidence of thrombosis within.

•C)**Axial TOF MIP **shows the fistula site to be located along the anterior, inferior
and lateral aspects of the sac with prominent feeders from left internal carotid
artery.

•**D)Sagittal Volume rendered **images show prominent arterial feeders from left
middle meningeal artery and left occipital artery.

•**E**)** Axial ASL **sequence shows increased perfusion(arterial flow),suggestive
of arteriovenous fistula.

•F)** Coronal MRV MIP **shows this dilated sac terminating as a prominent left sigmoid
sinus with its continuity with the left internal jugular vein not being visualized,
due to chronic occlusion.

•G) **Axial T1 PC **shows pprominent posterior fossa veins.

•H) **Axial TOF MIP **shows prominent bilateral superficial and deeper middle cerebral
veins (right more than left) as well as dilated superior ophthalmic veins (right
more than left) further draining across the canthi into supratrochlear veins been
much more prominent in the right medial canthus. Also the dilated right superior
ophthalmic vein is seen causing relative mass effect in the form of proptosis of
the right eyeball.

## **Dural sinus malformation (DSM)**

•Dural sinus malformation (DSM) is a rare congenital malformation which contains
a dilated dural sinus pouch that communicates with the other sinuses and drains 
cerebral veins.

•They have been classified anatomically into a midline type and a lateral type, 
primarily based on the location.

• The midline type involves the posterior sinus with or without the torcula, with
giant dural lakes and slow flow mural arteriovenous shunting, associated with spontaneous
thrombosis, hemorrhagic infarction and a poorer prognosis.

•The lateral type involves the jugular bulb with otherwise normal sinuses and an
associated high flow sigmoid sinus arteriovenous fistula. It has a good prognosis
due to normal contralateral drainage pathway

**Dural sinus malformation (DSM)**

•**Pathogenesis- **Normal gestational remodelling of the ballooned sinuses is impeded
by the high venous pressure due to the presence of dural arteriovenous fistulas.

•Another theory is that it results from excessive and disorganized development of
the posterior sinuses, when they should be decreasing in size.

•**References-** •1. Fetal imaging of a rare case of dural sinus malformation: a
case report. Kavya S. Kaushik, Ullas V. Acharya*, Rupa Ananthasivan, Bhavana Girishekar,
Priyanka Kalidindi and Pooja G. Patil.

•2. Dural Sinus Malformations (DSM) with Giant Lakes, in Neonates and Infants. Review
of 30 Consecutive Cases. M. Barbosa, J. Mahadevan.