A 27-year-old woman 10 days postpartum presents with severe progressive headache, papilledema, and two focal seizures. Non-contrast CT shows a left parasagittal hemorrhagic infarct. Contrast CT demonstrates the empty delta sign. Which structure is thrombosed?
- A Superior sagittal sinus ✓
- B Basilar artery
- C Middle cerebral artery
- D Straight sinus
Correct answer: A. Superior sagittal sinus
Explanation
The empty delta sign, contrast filling the dural leaves around an unfilled triangular lumen seen on post-contrast imaging, indicates superior sagittal sinus thrombosis. Postpartum hypercoagulability, parasagittal hemorrhagic venous infarcts sparing arterial territories, seizures, and raised intracranial pressure all fit. Management is anticoagulation with heparin even when hemorrhagic infarction is present. Basilar artery occlusion causes brainstem ischemia, not this picture.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.