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|Year : 2016 | Volume
| Issue : 5 | Page : 1098-1099
Focal brain herniation into a dural venous sinus: An incidental rare entity
Vikas Bhatia, Sameer Vyas, Anuj Prabhakar, Paramjeet Singh, Niranjan Khandelwal
Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
|Date of Web Publication||12-Sep-2016|
Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhatia V, Vyas S, Prabhakar A, Singh P, Khandelwal N. Focal brain herniation into a dural venous sinus: An incidental rare entity. Neurol India 2016;64:1098-9
A 19-year male presented with a single episode of partial seizures. Contrast-enhanced magnetic resonance imaging (MRI) [Figure 1] and [Figure 2] showed a circumscribed lesion within the distal transverse sinus, which was contiguous with the left temporal lobe, and the signal characteristics were isointense to brain parenchyma. The lesion was surrounded by cerebrospinal fluid (CSF). These findings were consistent with focal brain herniation into a dural venous sinus.
|Figure 1: Axial T2 (a), axial fluid attenuation inversion recovery (FLAIR, b) and sagittal 3D gradient T1 images showing a well-defined lesion in the left transverse sinus with signal intensity isointense to brain with surrounding CSF (arrows). Pre-contrast (C) and postcontrast T1 image (d) showing the enhancing left transverse sinus with herniated brain parenchyma (arrow)|
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|Figure 2: Coronal CISS image (a) showing focally herniated left temporal lobe into the left transverse sinus with surrounding CSF (arrow). Postcontrast 3D T1 gradient image (b) showing a small ring enhancing lesion in the frontal lobe (arrow) consistent with neurocysticercosis|
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Herniation of brain parenchyma into a dural venous sinus is an incidentally detected rare finding. It is postulated to occur spontaneously or as a result of increased intracranial pressure, in preexisting arachnoid granulations. The herniated brain surrounded by CSF shows a signal intensity similar to that of normal brain parenchyma surrounded by subarachnoid spaces on all MRI pulse sequences. The differential diagnosis of lesions seen in the dural sinuses include dural thrombosis, arachnoidal granulations, calvarial lesions, meningiomas, metastases, dermoids, epidermoids, and arachnoid cysts.
Arachnoid granulations are focal protrusions of the leptomeninges into the dural venous sinus lumen, which are found in the normal population. Computed tomography (CT) and MRI signals show the contents with their signal intensity usually paralleling that of CSF; however, a hyperintense signal is observed on fluid-attenuated inversion-recovery images in up to 10% of cases. Dural thrombosis shows a varied signal intensity on MRI depending on the duration of the thrombus and the pulse sequence used. The use of newer sequences such as three-dimensional gradient T1 echo and constructive interference in steady state (CISS) have a very high spatial resolution and help in optimally visualizing the herniated brain within the dural sinus. The clinical significance and symptomatology of these herniations are uncertain and these may be more common than previously described or suspected.
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[Figure 1], [Figure 2]