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Images in Neurology
October 2007

Splenium Infarct Due to Cerebral Venous Thrombosis

Arch Neurol. 2007;64(10):1540. doi:10.1001/archneur.64.10.1540

A 21-year-old woman was delivered of a neonate 10 days earlier with the use of epidural anesthesia without complications. A few hours post partum, she developed postural headache that was subsequently treated with a blood patch; this resulted in modest improvement. She returned a week later with worsening right-sided throbbing headache that was exacerbated by head movement and associated with severe photophobia and nausea. She had no noteworthy medical history and was not taking any medications. Findings from neurological examination were normal without alexia, agraphia, hemineglect, or papilledema. Results of laboratory studies revealed normal electrolyte and glucose values. Magnetic resonance imaging of the head demonstrated a focal lesion of the splenium of the corpus callosum with an increased diffusion-weighted image (Figure, A) and a corresponding decreased signal on apparent diffusion coefficient map (Figure, B) consistent with an ischemic etiology. Magnetic resonance venography revealed partial superior sagittal sinus and complete right transverse sinus thrombosis (Figure, C). Subsequently, the patient was started on anticoagulation with resolution of headache in the next few days.

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