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

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