A 13-year-old girl with chronic immune thrombocytopenia who was taking eltrombopag, a thrombopoietin-receptor agonist, and combined oral contraceptive pills presented to the emergency department with 3 weeks of severe intermittent headaches, nausea, and low-grade fevers. Neurologic examination was normal. Platelet count was 125 000/μL. Brain magnetic resonance imaging (Figure 1) showed an occlusive thrombus in the anterior superior sagittal sinus with some extension into cortical veins. A nonocclusive thrombus was present in the left transverse sinus. Also present was bifrontal pachymeningeal dural thickening and enhancement as well as bifrontal leptomeningeal enhancement (Figure 2). The leptomeningeal enhancement was favored to represent bacterial meningitis. Another possibility raised at the time of the interpretation was that the leptomeningeal and dural enhancement were entirely attributable to vascular changes from the sinus venous and cortical vein thrombosis.
Lozano-Chinga M, Linscott LL, Afify Z. Leptomeningeal Enhancement Associated With Cerebral Venous Thrombosis. JAMA Neurol. 2022;79(2):195–196. doi:10.1001/jamaneurol.2021.4359
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