Search

Subarachnoid hemorrhage (SAH) is a major cause of hemorrhagic stroke with substantial morbidity and mortality. Cerebral venous and/or sinus thrombosis can result in SAH in rare occasions, representing a mechanism for atraumatic, non-aneurysmal SAH that does not have another clear physical mechanism. A 54 year-old female with acute thunderclap headache presented to the emergency department with right sylvian fissure SAH. DSA revealed right cavernous sinus thrombosis, bilateral hypoplastic veins of Trolard, and an engorged right superficial middle temporal vein. Hypercoagulable work-up revealed an elevation of Factor VIII. We propose a unique mechanism for a case of atraumatic, non-aneurysmal SAH, in which we infer that bilateral hypoplasia of the superior anastomotic veins (of Trolard) resulted in a predisposition toward cerebral venous hypertension, resulting in SAH due to venous rupture.

Cerebral venous thrombosis (CVT) is an uncommon cause of hemorrhagic stroke. A 47-year old woman presented with acute-onset global aphasia and right hemiplegia. Head CT revealed a large left frontoparietal hematoma with significant mass effect. Emergency decompressive hemicraniectomy and hematoma evacuation were thus indicated. Intraoperatively, an occlusive thrombus was identified in the superior anastomotic vein of Trolard, confirming the diagnosis of CVT. While hemorrhagic CVT is not a rare entity, the diagnosis is not usually made intraoperatively. More interestingly, the authors provide intraoperative photographs of the occlusive thrombus in the vein of Trolard, overlying the area of hemorrhage, which they believe are unique and compelling clinical images. Keywords: Cerebral venous thrombosis, Dural sinus thrombosis, Intracerebral hemorrhage, Superior anastomotic vein of Trolard, Thrombophilia, Venous infarction