Utility of diagnostic cerebral angiogram in a patient with fluctuating aphasia and presumed left atretic transverse sinus on noninvasive imaging modalities

Abstract

A 46-year-old female presented with headache and fluctuating aphasia. CT head/angiogram and magnetic resonance image/venogram were nonconfirmatory for vascular pathology, although suggestive of left atretic transverse sinus.Diagnostic angiogram showed left temporal
venous congestion with delayed drainage of vein of
Labbe into the left transverse sinus. This territory of
venous drainage overlaps with the temporal branches of
middle cerebral artery; therefore, occlusion of the temporal venous branches causes infarction in the Wernicke’s area causing aphasia [1]. Hypoplasia or atresia of
cerebral sinuses may lead to inconclusive results on
MRV or CT and hence the venous phase of cerebral
angiography would serve to provide a higher clinical
yield in such cases.