When a plain CT brain looks like contrast-enhanced- never forget polycythemia

[...]diffuse hyperdensity involving intracranial arteries simultaneously with dural venous sinuses on NCCT is reported in hemoconcentration and polycythemia.1 2 While polycythemia vera has been discussed to be associated with this striking finding, association of secondary polycythemia in an adult w...

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Published inBMJ case reports Vol. 14; no. 9; p. e246106
Main Authors Biswas, Payel, Vardhan, Bhagya, Chatterjee, Subhankar, Kumar Ojha, Umesh, Dubey, Souvik
Format Journal Article
LanguageEnglish
Published London BMJ Publishing Group LTD 03.09.2021
BMJ Publishing Group
Subjects
Blood cancer
Cardiovascular disease
Case reports
Congenital diseases
Decision making
Heart
Hemoglobin
Images In
Medical imaging
Sinuses
Thrombosis
Veins & arteries
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Summary:[...]diffuse hyperdensity involving intracranial arteries simultaneously with dural venous sinuses on NCCT is reported in hemoconcentration and polycythemia.1 2 While polycythemia vera has been discussed to be associated with this striking finding, association of secondary polycythemia in an adult with complex CCHD is unique.1–3 Flowing blood measures 40 HU on CT scan at 45% haematocrit. Learning points Seizures in congenital cyanotic heart disease can be due to hypoxic spells, cerebral venous sinus thrombosis (CVST), embolic infarct or abscess due to infective endocarditis and vascular congestion secondary to polycythemia. Polycythemia and CVST can mimic each other with respect to neurological symptoms clinically and radiologically on non-contrast CT brain. [...]CVST itself being a complication of polycythemia, these two must be differentiated to guide therapeutic decision-making.
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ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-246106