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At least 253 records · Page 14Linked to original sources
PubMed2001

Postpartum postural headache due to superior sagittal sinus thrombosis mistaken for spontaneous intracranial hypotension.

PURPOSE: To describe a case of superior sagittal sinus thrombosis in the puerperal period and the difficulties encountered in the diagnosis and management. CLINICAL FEATURES: A 29-yr-old multiparous woman presented with a postural headache four weeks after a normal pregnancy and vigorous delivery. Initial presentation suggested spontaneous intracranial hypotension (SIH) since there was no history of epidural or spinal anesthesia, or trauma or surgery to her back or neck. Conservative therapy was initially offered and then a lumbar epidural blood patch (LEBP) was performed, although it failed to relieve the postural headache. A dural leak could not be demonstrated but an MRV (magnetic resonance venography) revealed a superior sagittal sinus thrombosis (SSST). Although anticoagulant therapy was immediately initiated, the neurologist remained convinced that the postural headache was secondary to SIH, and, consequently, a second epidural blood patch was requested. Anesthesia was reluctant to perform an LEBP at this point and suggested continuing anticoagulation until a subsequent MRV demonstrated recannalization of the SSST. This advice was followed and the postural headache resolved spontaneously with intravenous anticoagulation. CONCLUSION: The present case illustrates the importance of a multidisciplinary approach to the management of this rare complication of pregnancy. This case also highlights the importance of reviewing the differential diagnosis when considering treatment of a postural headache in the puerperium.

Adult↗
PubMedDate not supplied

Gadolinium-enhanced MR of chronic dural sinus thrombosis.

Gadopentetate dimeglumine-enhanced MR imaging was performed in four patients with chronic dual sinus thrombosis. After injection, intense enhancement of the chronic thrombus was observed in all cases. On three-dimensional time-of-flight MR angiography, performed in one case, the occluded part of the superior sagittal sinus was not distinguishable from a normal sinus because of thrombus enhancement mimicking blood flow. Enhancement of the clot is best explained by organization of the thrombus, which is converted into vascularized connective tissue. It could lead to false-negative results in patients with chronic dural sinus thrombosis studied with contrast-enhanced MR or contrast-enhanced time-of-flight MR angiography techniques.

Adult↗
PubMed1997

Ocular neuromyotonia in a patient with cavernous sinus thrombosis secondary to mucormycosis.

PURPOSE: To report a case of ocular neuromyotonia occurring after cavernous sinus thrombosis secondary to mucormycosis. METHODS: Case report. We performed serial comprehensive neuro-ophthalmologic examinations. RESULTS: Fifteen months after initial total ophthalmoplegia of the right eye and complete right upper eyelid ptosis, isolated ocular neuromyotonia, characterized by episodic upward jerking movements of the right upper eyelid, was noted. CONCLUSION: Ocular neuromyotonia, which usually manifests in patients with a history of intracranial tumors and cranial radiation, may also be secondary to infectious cavernous sinus thrombosis.

Adult↗
PubMed2005

An adult case of moyamoya syndrome that developed dural sinus thrombosis associated with protein C deficiency: case report and literature review.

We describe a 54-year-old woman exhibiting MMS who developed delayed dural sinus thrombosis associated with PCD. Angiographic findings of the patient were so unusual that bilateral internal carotid arteries were occluded between their origin and the carotid fork with extensive development of collateral circulation via the external carotid arteries and the posterior cerebral arteries instead of moyamoya vessels at the base of the brain. Seven years after bilateral cerebral revascularization surgery, intracerebral hemorrhage occurred caused by dural sinus thrombosis. In the treatment for the patient with MMS associated with PCD, risk of sinus thrombosis should be taken into account.

Age Factors↗
PubMed2003

Intracranial sinus thrombosis in a patient with Crohn disease and factor V Leiden mutation.

There is a well-known risk of thrombosis in patients with inflammatory bowel disease. Documented cases of intracranial sinus thrombosis in this setting are rare. We present the case of a 30-year-old man with Crohn disease who spontaneously developed a superior sagittal sinus thrombosis and bifrontal infarcts that resulted in death. The patient was heterozygous for factor V Leiden mutation. The literature was searched to assess the frequency of cerebral venous infarcts in inflammatory bowel disease and the role that factor V Leiden plays in thrombosis in such patients.

Adult↗
PubMed1994

[HELLP syndrome--amaurosis in sinus thrombosis with complete recovery].

We report on a case of a 22-year old primigravida with HELLP syndrome in association with blindness and cerebral sinus thrombosis. The diagnosis of the cerebral sinus thrombosis was based on MRI 1h after delivery. Immediate caesarean section and intensive care treatment led to a complete recovery of the patient.

Adult↗
PubMed2000

Epidural abscess masquerading as lateral sinus thrombosis.

Controversy regarding the use of anticoagulants, the evacuation of the sinus, or the use of medical treatment alone surrounds the treatment of lateral sinus thrombosis. Treatment of an epidural abscess associated with coalescent mastoiditis is much less controversial-drainage is usually recommended. The differing treatments of these complications mandate accurate diagnosis. The advent of more sophisticated radiological studies has facilitated diagnosis of these complications; however, tests are not infallible. We present three cases in which preoperative imaging demonstrates an epidural abscess mimicking lateral sinus thrombosis by compression of the vessel. A false-positive computed tomography (CT) or magnetic resonance imaging (MRI) study may lead to the wrong diagnosis and, consequently, improper treatment. In light of this possibility, we recommend surgical exploration in all such cases.

Case Reports↗
PubMed2004

Cerebral venous sinus thrombosis and thrombophilia presenting as pseudo-tumour syndrome following mild head injury.

Cerebral venous sinus thrombosis (CVT) after mild head injury is infrequent. A 38-year-old patient presented with a Glasgow Coma score (GCS) of 15 after a road traffic accident. CT scan revealed a temporal contusion. He was treated with measures to prevent cerebral oedema and anticonvulsants. Three weeks later he presented with features of pseudo-tumour syndrome. Investigations revealed the presence of cerebral venous sinus thrombosis, protein C deficiency and elevated titres of antiphospholipid antibodies. He was treated with anticoagulants and showed improvement. This case report highlights that multiple "hits" may lead to CVT and hence laboratory screening of patients with CVT is necessary even if the clinical situation seemingly provides sufficient explanation for a thrombotic event. The presence of acquired and inherited causes of thrombophilia need not always lead to symptomatic thrombosis. As illustrated by this case, a second hit, such as trauma, may be the precipitating factor that unmasks the prothrombotic state.

Adult↗
PubMed1982

[Reliability of CT diagnosis in cerebral sinus thrombosis].

There is no reliable CT diagnosis in all cases of cerebral sinovenous thrombosis. The hyperdense sinus structures may indicate an acute thrombotic occlusion, but we know other reasons of this finding. Only the so-called empty triangle sing is pathognomonic, while the unilateral or bilateral hemorrhages, circumscript or diffuse edema with small ventricles and the tentorial hypervascularity are not specific of sinovenous occlusion. We present our findings in 15 cases of sinovenous thrombosis and conclude, that the combination of clinical course and CT-finding with specific or some non-specific signs will give the correct diagnosis of sinus thrombosis with or without angiography.

Adolescent↗
PubMed1983

[Administration of mannitol for severe superior sagittal sinus thrombosis].

A cured case of superior sagittal sinus thrombosis is reported. The patient, a 26-year-old man, also displayed severe complications such as hemorrhagic infarction and status epilepticus. Although his prognosis was considered to be extremely poor, conservative treatment, with mannitol, steroid, anticonvulsants, etc. was effective, and he was discharged without any neurological deficit. This report discusses the clinical course, CT findings, angiographical findings and regional cerebral blood flow (rCBF). At first, CT showed no abnormal findings, but hemorrhagic infarction was detected on the 3rd day after the onset. Follow-up CT showed subcortical low density area, hemorrhagic infarction with perifocal brain edema, midline shift etc; the focus of hemorrhagic infarction was almost absorbed 2.5 months after the onset. Cerebral angiogram showed not only the obstruction of the superior sagittal sinus but also that of cortical veins of cerebral convexity at first. Follow-up angiogram showed the development of collateral circulations such as deep cerebral, ophthalmic and emissary veins. On CBF study, low rCBF at the bilateral parasagittal region was observed, but marked increase of rCBF was measured in the parasagittal region, especially at the site of hemorrhagic infarction after the administration of 20% mannitol. We, therefore, consider mannitol as an effective agent for the treatment of cerebral sino-venous thrombosis.

Adult↗
PubMedDate not supplied

Cerebral venous sinus thrombosis in children with acute lymphoblastic leukemia carrying the MTHFR TT677 genotype and further prothrombotic risk factors.

BACKGROUND: The present study was designed to prospectively evaluate the role of prothrombotic risk factors in leukemic children treated according to the ALL-BFM 90/95 study protocols with respect to the onset of cerebral venous sinus thrombosis. PATIENTS: 317 consecutive leukemic children aged 6 months to 18 years were enrolled in this study. 288 of the 317 patients were available for thrombosis-free survival analysis. RESULTS: In 17 (5.9%) of these 288 patients cerebral venous sinus thrombosis occurred. The overall event-free survival of thrombosis in the central nervous system in patients with at least one prothrombotic defect (n = 12) was significantly reduced compared with patients without a prothrombotic defect (p < 0.0001). 15 patients showed acute clinical symptoms at onset of cerebral venous sinus thrombosis, two were asymptomatic. Three of the 17 patients affected (17.6%) died directly associated with the thrombotic event during induction therapy, the remaining 14 patients did not show prolonged clinical symptoms. CONCLUSIONS: Prothrombotic risk factors should be included in a screening program in ALL children treated according to the BFM study protocols. Further prospective studies are recommended to establish adequate prophylactic anticoagulant treatment during ALL (BFM) polychemotherapy.

Adolescent↗
PubMed1999

Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy.

OBJECT: The goal of this study was to document the hazards associated with pseudotumor cerebri resulting from transverse sinus thrombosis after tumor resection. Dural sinus thrombosis is a rare and potentially serious complication of suboccipital craniotomy and translabyrinthine craniectomy. Pseudotumor cerebri may occur when venous hypertension develops secondary to outflow obstruction. Previous research indicates that occlusion of a single transverse sinus is well tolerated when the contralateral sinus remains patent. METHODS: The authors report the results in five of a total of 107 patients who underwent suboccipital craniotomy or translabyrinthine craniectomy for resection of a tumor. Postoperatively, these patients developed headache, visual obscuration, and florid papilledema as a result of increased intracranial pressure (ICP). In each patient, the transverse sinus on the treated side was thrombosed; patency of the contralateral sinus was confirmed on magnetic resonance (MR) imaging. Four patients required lumboperitoneal or ventriculoperitoneal shunts and one required medical treatment for increased ICP. All five patients regained their baseline neurological function after treatment. Techniques used to avoid thrombosis during surgery are discussed. CONCLUSIONS: First, the status of the transverse and sigmoid sinuses should be documented using MR venography before patients undergo posterior fossa surgery. Second, thrombosis of a transverse or sigmoid sinus may not be tolerated even if the sinus is nondominant; vision-threatening pseudotumor cerebri may result. Third, MR venography is a reliable, noninvasive means of evaluating the venous sinuses. Fourth, if the diagnosis is made shortly after thrombosis, then direct endovascular thrombolysis with urokinase may be a therapeutic option. If the presentation is delayed, then ophthalmological complications of pseudotumor cerebri can be avoided by administration of a combination of acetazolamide, dexamethasone, lumbar puncture, and possibly lumboperitoneal shunt placement.

Acetazolamide↗
PubMed1994

Superior sagittal sinus thrombosis after radical neck dissection.

Dural sinus thrombosis is a rare, potentially fatal complication of a radical neck dissection. The prognosis can vary from complete recovery to rapid death. Magnetic resonance venography provides an effective, noninvasive diagnosis. The goals of therapy are to decrease intracranial pressure and to lyse the thrombus. Systemic anticoagulation and systemic thrombolytics are controversial therapies. The direct intrasinus infusion of thrombolytic agents is under investigation.

Journal Article↗
PubMed1996

Bilateral papilledema with retinal hemorrhages in association with cerebral venous sinus thrombosis and paroxysmal nocturnal hemoglobinuria.

PURPOSE: To report a patient with paroxysmal nocturnal hemoglobinuria who complained of transient obscurations of vision and exhibited bilateral papilledema with retinal hemorrhages. METHODS: Case report. Computed tomography did not demonstrate any abnormality but magnetic resonance imaging disclosed signs of cerebral venous sinus thrombosis. RESULTS: The patient was treated with subcutaneous low molecular weight heparin and intravenous corticosteroids. Symptoms improved within one week and ophthalmoscopic signs resolved within four months. CONCLUSION: Bilateral papilledema with extensive retinal hemorrhages may be a sign of cerebral venous sinus thrombosis, a reported devastating complication of paroxysmal nocturnal hemoglobinuria. Thus, any patient with suspected cerebral venous sinus thrombosis should undergo magnetic resonance imaging, even when results of computed tomography are normal.

Anticoagulants↗
PubMed2006

Acute subarachnoid haemorrhage: a rare presentation of cerebral dural sinus thrombosis.

We report a case of cerebral dural sinus thrombosis presenting as acute subarachnoid haemorrhage and clinically mimicking an aneurysmal bleed. Awareness of this rare initial presentation of cerebral venous thrombosis is important and should be considered in the diagnostic work-up of acute subarachnoid haemorrhage. The radiologist plays a crucial role in making this often unsuspected but important diagnosis to enable prompt appropriate treatment.

Acute Disease↗
PubMed1982

Cavernous sinus thrombosis as a cause of unilateral blindness.

Cavernous sinus thrombosis (CST) rarely causes blindness. It is sometimes difficult to differentiate clinically from a severe orbital cellulitis. We studied a case of CST that evolved from osteomyelitis and orbital cellulitis in a patient who had a rapid loss of vision to the level of no light perception. Detailed clinical and electrophysiologic tests were performed to pinpoint the cause of blindness.

Adult↗