Objective:

To describe a rare case of lateral tentorial sinus thrombosis in a patient with sickle cell disease.

Background:

Tentorial sinuses are venous structures that are in the posterior cranial fossa, draining the occipital and temporal lobes and the superior part of the cerebellum. They are divided into the lateral tentorial sinus, which drains into the transverse-sigmoid sinus junction, and the medial tentorial sinus, which drains into the straight sinus. Despite its importance from the posterior cranial fossa surgical perspective, it is not a well-recognized location for cerebral venous thrombosis. Here, we present a rare case of tentorial sinus thrombosis in the setting of sickle cell disease.

Design/Methods:

Case report and review of the available literature.

Results:

A 26-year-old woman with sickle cell disease presented to the emergency department with a 2-day history of headache, nausea, and vomiting. Neurological exam was normal. CT brain revealed hyperdensity in the right occipital region in addition to subtle area of hypodensity in the right medial occipital lobe. MRI/MRV brain showed right lateral tentorial sinus and occipital cortical vein thrombosis in addition to a venous infarct in the right medial occipital lobe. The patient was started on therapeutic anticoagulation, initially with heparin with no complications; later she was transitioned to apixaban. Hemoglobin electrophoresis revealed HbS 80.6% and HbF 16.6%. The patient received an exchange transfusion and was discharged home in stable condition.

Conclusions:

In patients with symptoms concerning for cerebral venous thrombosis, attention is usually directed to the traditional dural venous sinuses and cortical veins, while other venous structures can be overlooked. Although, in this particular case, it was clear on imaging, tentorial sinus thrombosis can easily be missed if not associated with brain edema or venous infarct.