Hemorrhagic infarction secondary to cerebral venous thrombosis

Cerebral venous thrombosis (CVT) is an uncommon cause of hemorrhagic stroke. A 47-year old woman presented with acute-onset global aphasia and right hemiplegia. Head CT revealed a large left frontoparietal hematoma with significant mass effect. Emergency decompressive hemicraniectomy and hematoma evacuation were thus indicated. Intraoperatively, an occlusive thrombus was identified in the superior anastomotic vein of Trolard, confirming the diagnosis of CVT. While hemorrhagic CVT is not a rare entity, the diagnosis is not usually made intraoperatively. More interestingly, the authors provide intraoperative photographs of the occlusive thrombus in the vein of Trolard, overlying the area of hemorrhage, which they believe are unique and compelling clinical images.