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Images in Neurology
December 6, 2021

Leptomeningeal Enhancement Associated With Cerebral Venous Thrombosis

Author Affiliations
  • 1Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Utah, Primary Children’s Hospital, Salt Lake City
  • 2Department of Medical Imaging, Primary Children’s Hospital, Salt Lake City, Utah
JAMA Neurol. 2022;79(2):195-196. doi:10.1001/jamaneurol.2021.4359

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.

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