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PubMed1988

Superior sagittal sinus thrombosis. Still a killer.

Following treating a case of superior sagittal sinus thrombosis, we did an extensive search of the literature, eliciting 795 cases of the disorder. An analysis showed that even after the introduction of antibiotics, the preponderance of these cases have been diagnosed at autopsy. Our findings raise questions about the current methods of diagnosis and management of superior sagittal sinus thrombosis: Can the correct diagnosis be made earlier? Does a distinction between partial and complete thrombosis call for a different management?

Adult↗
PubMed1980

Stroke during pregnancy and puerperium in young females below the age of 40 years as a result of cerebral venous/venous sinus thrombosis.

One hundred and thirty-eight cases of cerebral venous/venous sinus thrombosis during the puerperium have been studied. Maximum number of cases (112 cases) occurred in the age below 30 years. Signs and symptoms appeared in most of the cases (72 cases) during the first 7 days of post partum period. One hundred and eleven cases were multipara. Commonest signs and symptoms were fever (85 cases); headache (66 cases), convulsions (64 cases), altered consciousness (57 cases), hemiplegia (60 cases), papilloedema (48 cases), etc. Carotid angiography done in 55 cases revealed block in middle part of superior sagittal sinus in 24, and localised, dilated and tortuous cortical veins in 5. A statistically significant rise in serum triglycerides, phospholipids, free fatty acids, blood platelet count, platelet adhesive index, and fall in blood fibrinolytic activity were found as compared with normals. These factors may be playing a role in the etiology of cerebral venous/venous sinus thrombosis during puerperium.

Adolescent↗
PubMed2006

Occurrence of cerebral venous sinus thrombosis in patients with presumed idiopathic intracranial hypertension.

PURPOSE: To report the rate of occurrence of cerebral venous sinus thrombosis (CVST) in patients with presumed idiopathic intracranial hypertension (IIH). DESIGN: Retrospective chart review. PARTICIPANTS: All patients diagnosed with papilledema from November 1, 2002, through October 31, 2003, at 3 tertiary care neuro-ophthalmology centers. METHODS: Consecutive patients with a diagnosis of papilledema from 3 tertiary care neuro-ophthalmology centers were identified. Patients with space-occupying lesions, hydrocephalus, or meningitis were excluded. The remaining patients were evaluated with lumbar puncture, magnetic resonance imaging (MRI), and magnetic resonance venography (MRV). MAIN OUTCOME MEASURES: The rate of occurrence of CVST in patients with presumed IIH. RESULTS: One hundred thirty-one patients with papilledema were identified. Excluding patients with mass lesions, meningitis, or hydrocephalus, the occurrence of CVST was 10 (9.4%) of 106 patients with presumed IIH. Two additional patients had a diagnosis of suspected CVST. Cerebral venous sinus thrombosis was diagnosed in 1 of the 10 patients with MRI alone, whereas it was evident in all 10 patients with MRV. Underlying risk factors for CVST were identified in 9 of 10 patients. CONCLUSIONS: Cerebral venous sinus thrombosis accounts for 9.4% of patients with presumed IIH in 3 tertiary care neuro-ophthalmology services. Magnetic resonance venography in combination with MRI is recommended to identify this subgroup of patients.

Adolescent↗
PubMed2001

Improvement in papilledema and visual loss after endovascular stent placement in dural sinus thrombosis.

OBJECTIVE: To report two cases of cerebral venous sinus thrombosis with papilledema and visual loss that improved after endovascular stent placement. MATERIALS AND METHODS: Retrospective case series from a tertiary ophthalmic center. RESULTS: Two cases of venous sinus occlusion treated with angioplasty and stenting are described. Both cases experienced improvement in optic disc edema and visual function following the procedures. CONCLUSION: Endovascular stent placement may relieve increased intracranial pressure and papilledema caused by cerebral sinus thrombosis and may prevent further visual loss.

Journal Article↗
PubMed2006

Subtle computed tomography abnormalities in cerebral deep sinus thrombosis.

A patient with cerebral deep sinus thrombosis, which was not diagnosed on the first examination, is reported. A 46-year-old woman presented with headache and vomiting. Neurological examination and a brain computed tomography (CT) scan showed no obvious abnormal findings. The patient suffered disturbed consciousness on the day after the examination, and was admitted to our emergency centre. A CT scan and magnetic resonance imaging revealed an ischaemic lesion in the left basal ganglia, suggesting deep sinus occlusion. Anticoagulant therapy was administered. One day after admission, a CT scan showed a haematoma and severe brain swelling in the same region. Cerebral angiography demonstrated a straight sinus occlusion. Intracranial pressure was not controlled with hypothermia, and the patient died 25 days after admission. Review of the initial CT scan revealed subtle, early findings of deep venous thrombosis that were missed on first examination.

Anticoagulants↗
PubMed1991

Bilateral blindness in cavernous sinus thrombosis.

An unusual case of bilateral blindness secondary to a cavernous sinus thrombosis is reported. A woman who had undergone reconstructive surgery after tumor resection of the floor of the mouth, was readmitted 1 month later with bilateral proptosis and signs of sepsis. There were no complaints of blurred vision. A CT-scan of the orbits demonstrated a bilateral cavernous sinus thrombosis (CST) secondary to an infection at the skull base behind the myocutaneous flap. A few days later she became blind, due to bilateral central retinal artery occlusion and anterior ischemic optic neuropathy. The general critical condition improved with intensive AB treatment. The patient recovered well without neurological defects apart from her permanent bilateral blindness. There were no signs of tumor recurrence. To our knowledge, this is the first documented case of bilateral blindness in a patient suffering from CST.

Blindness↗
PubMed1991

Atypical MRI findings of venous sinus thrombosis in pregnancy: clinical significance relating to episodic vascular headache.

Two cases of headache during pregnancy were associated with MRI findings suggestive of venous sinus thrombosis. The findings, however, were atypical, and of uncertain clinical significance. Venous sinus thrombosis typically does not occur during the first and second trimesters (less than 10 percent of reported cases). Thus, these two cases are doubly unusual. The correct significance of these equivocal MRI findings of possible venous sinus thrombosis must be understood so that unnecessary and potentially harmful therapies are not employed, and so that appropriate management of what may otherwise be a typical vascular headache syndrome may be undertaken.

Adult↗
PubMed2004

Androgen-induced cerebral venous sinus thrombosis in a young body builder: case report.

BACKGROUND: Cerebral venous sinus thrombosis is an infrequent disease with a variety of causes. Pregnancy, puerperium, contraceptive pills and intracranial infections are the most common causes. The patient may present with headache, focal neurological deficits and seizures.The clinical outcome is highly variable and treatment with heparin is advised. CASE PRESENTATION: The patient is a 22 year old male who presented with headache, repeated vomiting and papilledema.He was a bodybuilder doing exercise since 5 years ago, who had used nandrolone decaonoate 25 milligrams intramuscularly during the previous 5 months. Brain MRI and MRV showed superior sagital and transverse sinus thrombosis and extensive investigations did not reveal any known cause. CONCLUSIONS: We suggested that androgen was the predisposing factor in our patient. Androgens may increase coagulation factors or platelet activity and cause arterial or venous thrombosis. As athletes may hide using androgens it should be considered as a predisposing factor for thrombotic events in such patients.

Adult↗
PubMed2004

Mastoid effusion associated with dural sinus thrombosis.

We present a series of three patients with mastoid air cell effusions associated with adjacent lateral sinus thrombosis. In all of these cases, the findings support the hypothesis that the mastoid effusion is secondary to sinus thrombosis rather then the other way around. Also shown is the chronology and natural evolution of mastoid air cell effusion secondary to sinus thrombosis as seen on planar imaging.

Adult↗
PubMed1995

Venous transcranial Doppler ultrasound monitoring in acute dural sinus thrombosis. Report of two cases.

BACKGROUND AND PURPOSE: We sought to establish the efficacy of the Doppler technique in the evaluation of the intracranial venous system and to assess its usefulness in the monitoring of venous collateral pathways in superior sagittal sinus thrombosis. METHODS: Venous Doppler ultrasound was performed with a range-gated 2-MHz transducer in 10 healthy volunteers and in two patients with superior sagittal sinus thrombosis confirmed by cerebral angiography. RESULTS: In normal control subjects, a venous signal was found at a depth ranging from 40 to 72 mm, which was considered to correspond to the deep middle cerebral vein and the basal vein of Rosenthal. Mean blood flow velocities ranged from 9 to 20 cm/s. In both patients with superior sagittal sinus thrombosis, Doppler studies detected elevated mean blood flow velocities (146 and 33 cm/s), which normalized after 16 weeks and 1 week, respectively. CONCLUSIONS: Venous transcranial Doppler ultrasonography provides a reliable, noninvasive, and rapid technique for intracranial venous examination. It was performed without difficulty in young health volunteers, and it can be applied as a monitoring tool in the evaluation of collateral venous flow in superior sagittal sinus thrombosis.

Acute Disease↗
PubMed1989

Calcified cerebral sinus thrombosis in infancy--CT appearances with pathological correlation.

A case of calcified cerebral venous sinus thrombosis in an infant is described, with autopsy correlation. Calcification of sinus thrombosis is rare. A triangular calcific density was demonstrated in the superior sagittal sinus, with extension of linear calcification laterally into the transverse sinuses. Following intravenous contrast administration there was intense enhancement of the superior sagittal and transverse sinuses around the calcified thrombus. The cerebral hemispheres showed generalised atrophy. Autopsy confirmed a calcified venous sinus thrombus. Triangular calcium density within the sagittal sinus or linear calcification within the transverse sinuses would appear to be characteristic of calcified cerebral sinus thrombus.

Calcinosis↗
PubMedDate not supplied

Appearance and disappearance of empty delta sign in superior sagittal sinus thrombosis.

The diagnostic value of the empty delta sign on post-infusion CT films was investigated in five patients with superior sagittal sinus thrombosis subsequently verified angiographically and/or pathologically. The empty delta sign, which has been considered to be unique and reliable in the diagnosis of cerebral venous sinus occlusion, was observed only on CT films taken one to four weeks after onset, and was not seen in the extremes of the acute or the chronic stage of the illness. These observations may explain why this sign has not been apparent in some reports concerning the CT findings of superior sagittal sinus thrombosis. Recanalization within the thrombus may be the reason why this sign was no longer apparent in the chronic stage of the patients with superior sagittal sinus thrombosis.

Adult↗
PubMed2006

Otitic hydrocephalus associated with lateral sinus thrombosis and acute mastoiditis in children.

The incidence of intracranial complications of acute otitis media (AOM) has decreased and the need for operative and medical treatment is declined during the antibiotic era. To describe pathognomonic signs, evaluation management, operative findings, clinical course and outcome of otitic hydrocephalus and lateral sinus thrombosis as complications of AOM and mastoiditis in pediatric patients. Two children, 9 and 13 years old, with the diagnosis of OH and TK and MRI findings are presented. Intracranial complications in children resulted from unsuccessful treatment of AOM, which led to acute mastoiditis and lateral sinus thrombosis. Both of the presented children had thrombus in their sigmoid sinus preoperatively, demonstrated by MRI, causing decreased blood flow. Both patients underwent a mastoidectomy and delamination of sigmoid sinus with puncture of sinuses. After medical and surgical treatment, blood flow through the sinus increased significantly. In both cases signs of increased intracranial pressure ceased. The clinical presentation of otogenic lateral sinus thrombosis (LST) as a complication of acute otitis media (AOM) can be masked by antibiotic treatment. The episodes of vomiting, headache, visual impairment and a history of AOM seem to be indicative for otitic hydrocephalus. MRI scans of patients with similar symptoms should be carefully studied to facilitate the early diagnosis of dural sinus thrombosis with increased intracranial pressure. Contrast-enhanced computed tomography scan and magnetic resonance imaging play a major role in determining diagnosis and treatment plans in this intracranial complications. Management included systemic antibiotics, short-term heparin anticoagulation and surgical decompression. In our patients intensive i.v. antibiotic treatment, steroids, anticoagulants and surgery led to a significant improvement in the clinical condition.

Acute Disease↗
PubMed1978

Ischemic optic neuropathy in cavernous sinus thrombosis.

Visual loss is uncommon in thrombosis of the cavernous sinus. A patient observed closely in the acute stages developed high introcular and intraorbital pressures. Although the retinal vasculature remained patent, total unilateral blindness occurred within 48 hours. To our knowledge this is the first documented case in which ischemic optic neuropathy caused blindness in a patient suffering from cavernous sinus thrombosis.

Adult↗
PubMed1997

Use of magnetic resonance imaging and magnetic resonance angiography in diagnosis of sigmoid sinus thrombosis.

Magnetic resonance angiography is an established radiologic technique which is rapidly becoming useful in imaging the head and neck. Currently, this imaging modality is important in the diagnosis of sigmoid sinus thrombosis caused by otologic disease. Since the introduction of antibiotic therapy, the percentage of deaths attributed to intracranial complications from otitic disease has decreased from 2.5 to approximately 0.25% of documented deaths. Also, the incidence of sinus thrombosis within this group has decreased, but it is still a serious and potentially lethal condition. Sinus thrombosis is suspected clinically when mastoid disease progresses, with picket fence fever pattern, chills, headaches and signs of papilledema. Definitive diagnosis is necessary before surgical treatment. The Queckenstedt test is unreliable, computed tomography is better suited for demonstrating thrombosis of the sagittal sinus rather than the sigmoid sinus, and conventional angiography (although it provides excellent visualization) has the hazard of ionizing radiation and requires vessel puncture and the use of intraarterial contrast agents. We present two cases of thrombosis of the sigmoid sinus as an intracranial otologic complication which were diagnosed definitively with magnetic resonance imaging and magnetic resonance angiography. The combination of magnetic resonance imaging, which showed the thrombosis displaying abnormal signal intensity, and magnetic resonance angiography, which demonstrated the absence of flow in the sinus, was an ideal diagnostic tool. For both patients, treatment consisted of mastoidectomy, sigmoid sinus decompression and antibiotics.

Adolescent↗
PubMed2000

Emergency endovascular treatment of cerebral sinus thrombosis with a rheolytic catheter device.

Severe thrombosis of the superior sagittal, transverse, and straight sinuses developed in a 53-year-old woman. This resulted in extensive multifocal hemorrhagic venous infarction and severe intracranial hypertension refractory to intensive management. Endovascular therapy using a rheolytic catheter device in combination with a small amount of fibrinolytic agent led to rapid normalization of the intracranial pressure, allowing optimization of the cerebral perfusion pressures and was followed by steady, albeit protracted, clinical improvement. The patient not only survived but also left the hospital with minimal neurologic deficit. The rheolytic catheter endovascular treatment is, in the opinion of the authors, the treatment of choice for patients with life-threatening cerebral sinus thrombosis.

Angioplasty, Balloon↗
PubMed1984

Diagnosis of superior sagittal sinus thrombosis by computerized tomography. Report of two cases.

Superior sagittal sinus thrombosis was diagnosed on computerized tomography (CT) scanning and was subsequently confirmed by angiography in two patients. Small ventricles and filling defects occurring within the sinus (the empty triangle sign) appeared to be highly suggestive of superior sagittal sinus thrombosis, and the association was confirmed angiographically. Potential pitfalls in the CT diagnosis of local obstruction of cerebral venous outflow are described and correlated with the natural history of the disease. The need for improved awareness of the CT appearance of occlusive disease of the dural venous sinuses is stressed.

Adult↗