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Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 3  |  Page : 779

The “Hockey-Stick” Sign: Spontaneous Unilateral Basal Vein Thrombosis


1 Neuroradiology Section, Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh, India
2 Department of Internal Medicine, PGIMER, Chandigarh, India

Date of Submission17-Feb-2020
Date of Decision23-Apr-2020
Date of Acceptance12-Jul-2020
Date of Web Publication24-Jun-2021

Correspondence Address:
Vikas Bhatia
Neuroradiology Section, Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.319206

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How to cite this article:
Chakrabarti R, Bhatia V, Saroch A. The “Hockey-Stick” Sign: Spontaneous Unilateral Basal Vein Thrombosis. Neurol India 2021;69:779

How to cite this URL:
Chakrabarti R, Bhatia V, Saroch A. The “Hockey-Stick” Sign: Spontaneous Unilateral Basal Vein Thrombosis. Neurol India [serial online] 2021 [cited 2021 Jul 25];69:779. Available from: https://www.neurologyindia.com/text.asp?2021/69/3/779/319206




A 19-year-old, previously well, female presented to the emergency department with progressively increasing right-sided weakness and severe headache. On examination, her right upper limb power was 3/5 and her right lower limb power was 2/5. Laboratory serum markers including coagulogram were all within normal limits.

An non-contrast computed tomography followed by CT venography of the head was acquired [Figure 1], which revealed linear hyperdensity resembling a “hockey-stick” on axial images along with the left ambient cistern, in the expected location of the left basal vein of Rosenthal on non-contrast images (analogous to the “cord sign” of cortical venous thrombosis) and non-opacification of the basal vein on CT venography, confirming the presence of thrombus. The patient underwent further workup with a thrombophilia screen, but all were normal. After starting on low molecular weight heparin, there was a gradual improvement in the patient's symptoms.
Figure 1: Axial non-contrast computed tomography (a) reveal hyperdensity in left basal vein with non-opacification (arrow) on contrast-enhanced CT images (b). A hockey stick (c); large arrow representing the head of the stick (prepeduncular course) and the small arrow representing shaft of the stick (ambient course) of the vein

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Isolated spontaneous thrombosis of the basal vein is very rare and we came across only one such report by Qiu et al.,[1] wherein the authors described the MRI appearance of the entity. Imaging in their case was done after several days and revealed few hyperintense T1-weighted foci in the left ambient cistern and non-opacification of the left basal vein of Rosenthal on contrast MR venography. Owler et al.[2] have described a post-traumatic basal vein thrombosis with venous infarction which was initially thought to be a low-grade glioma and confirmed as basal vein thrombosis after the biopsy.

Our case highlights the early identification of this rare identity on imaging for early diagnosis which is similar to cord sign described for cortical venous thrombosis.[3],[4] We propose to name this characteristic non-contrast computed tomography finding as to the “Hockey-stick” sign, evoking common imagery for a rare entity which if misdiagnosed can have catastrophic consequences.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Qiu MJ, Tian J, Luo W, Zhang BR. Unilateral isolated basal vein thrombosis associated with deep cerebral venous infarction. Chin Med J (Engl) 2018;131:1744-45.  Back to cited text no. 1
    
2.
Owler BK, Warrier S, Besser M. Traumatic unilateral deep cerebral venous infarction. J Clin Neurosci 2004;11:767-70.  Back to cited text no. 2
    
3.
Poon CS, Chang JK, Swarnkar A, Johnson MH, Wasenko J. Radiologic diagnosis of cerebral venous thrombosis: Pictorial review. AJR 2007;189:S64-S75.  Back to cited text no. 3
    
4.
Mathukumalli NL, Dandu R, Kanikannan MA, Kaul S. Clinicoradiological profile of superficial middle cerebral vein thrombosis. Neurol India 2020;68:373-7.  Back to cited text no. 4
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