A case of superior sagittal sinus thrombosis with choked disk

Background: Superior sagittal sinus thrombosis (SSST) is one of the causes of increased intracranial pressure and pseudotumor cerebri. The diagnosis of SSST is difficult to arrive at using conventional computed tomography (CT) and magnetic resonance imaging (MRI) alone. Case Report: We report a case of SSST in which the initial symptom was bilateral blurred vision due to a "choked disc". A 71-year-old male was referred to Kyushu University Hospital with bilateral papilledema with transient blurred vision. Although his intracranial pressure was increased, there was no intracranial space-occupying lesion. Dilatation of cerebral ventricles was not detected by conventional CT and MRI. The cause of "choked disc" was diagnosed as SSST when MR angiography failed to show the superior sagittal sinus. Carotid angiography showed the presence of a dural arteriovenous malformation (dural AVM), which was presumably a major cause of SSST in this case. The patient's ocular symptoms improved with diuretic therapy to lower intracranial pressure. Conclusion: MR angiography was useful in the diagnosis of SSST in this case of choked disc with increased intracranial pressure.