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Subarachnoid hemorrhage in 39-year-old woman (image study)

(A, B) Head CT without contrast demonstrates right temporo-occipital and superior left frontal subarachnoid hemorrhage. The superior sagittal sinus is hyperdense. (C) Head CT angiography shows no enhancement of the right sigmoid sinus and right jugular bulb. The ipsilateral sigmoid groove and jugular foramen are normal in caliber, indicating that the vessels in this region are not hypoplastic or atretic but are thrombosed. (D) Left internal carotid artery injection, AP view. There is extensive venous hypertension in the left cerebral hemisphere and hardly any opacification of the superior sagittal sinus (arrow). (E) Right internal carotid artery injection, ipsilateral oblique view. Nearly complete superior sagittal sinus thrombosis (arrows). (F) Left internal carotid artery injection, lateral view. Several filling defects (arrows) consistent with thrombus are noted in paramedian left frontal cortical veins. (Contributed by Dr. Jose Biller.)