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Click 64 year old female patient, extensive venous sinus thrombosis with bilateral superior ophthalmic vein thrombosis. Diffusion weighted images (1.5T MRI, Siemens Avanto. TR: 3100ms, TE: 96ms, ep_b0_1000, 5 mm slice thickness) & corresponding apparent diffusion coefficient images (1.5T MRI, Siemens Avanto. TR: 3100ms, TE: 96ms, ep_b0_1000, 5mm slice thickness) show hyperintensity & hypointensity respectively in the right temporal region, cavernous sinus bilaterally (left > right), bilateral SOV, anteriorly in the soft tissues of the nose extending medially in the right orbital region and focally in the straight sinus consistent with restriction of diffusion. Also noted are parenchymal ring like regions in the right basifrontal region which show peripheral hyperintensity & hypointensity respectively on diffusion weighted images & corresponding apparent diffusion coefficient images again comnsistent with restricted diffusion.

Click 64 year old female patient, extensive venous sinus thrombosis with bilateral superior ophthalmic vein thrombosis. Fat saturated contrast (Omniscan 0.1 mmol/kg body weight) enhanced spin echo T1 weighted axial image (TR: 847 ms, TE: 11ms, 5mm slice thickness) shows ring enhancing abscesses in the basifrontal region with daughter abscess medially. Enhancement is also noted in the soft tissues of the right temporal region and nasal soft tissues. Filling defects are noted in the cavernous sinus bilaterally. Also note the pachymeningeal enhancement and subdural empyema along the right frontal region.

Click 64 year old female patient, extensive venous sinus thrombosis with bilateral superior ophthalmic vein thrombosis. Contrast (Omniscan 0.1 mmol/kg body weight) enhanced spin echo T1 weighted sagittal image shows associated complications. Multiple abscesses in the soft tissues of the forehead, intraorbitally, in the pharyngeal soft tissue, intracranially as pachymeningeal enhancement, subdural empyema and parenchymal abscess.

Click 64 year old female patient, extensive venous sinus thrombosis with bilateral superior ophthalmic vein thrombosis. Contrast (Omniscan 0.1 mmol/kg body weight) enhanced MR venogram (1.5T MRI, Siemens Avanto, TR: 3.7, TE: 1.2, FLASH 3D sequence) shows thrombosis of the superior sagittal sinus and bilateral transverse sinuses . Incidental patent occipital sinus noted. Bilateral sigmoid sinuses and internal jugular veins are well seen.

Click 52 year old female patient with left sided indirect carotico cavernous fistula with post- embolisation left superior ophthalmic vein thrombosis. Digital subtraction angiogram -lateral and antero-posterior images of left external carotid artery pre embolisation show early filling of the cavernous sinus that drains anteriorly to the partially thrombosed SOV. The lumen of SOV shows a meniscus sign which is secondary to the intraluminal clot.

Click 52 year old female patient with left sided indirect carotico cavernous fistula with post- embolisation left superior ophthalmic vein thrombosis. Digital subtraction angiogram -lateral images of the left external carotid artery post embolisation show no residual vascular blush immediate post embolisation.

Click 52 year old female patient with left sided indirect carotico cavernous fistula with post- embolisation left superior ophthalmic vein thrombosis. Diffusion weighted axial image (1.5T MRI, Siemens Avanto, TR: 3500, TE: 105, 5mm slice thickness, ep _ b 1000t) and corresponding apparent diffusion coefficient images (1.5T MRI, Siemens Avanto , TR: 3500, TE: 105, 5mm slice thickness, ep _ b0_ 1000) respectively show hyperintense signal and corresponding hypointense signal within the enlarged left SOV consistent with restricted diffusion.