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PubMed2005

[A patient with sinus thrombosis associated with paroxysmal nocturnal hemoglobinuria].

A 27-year-old woman with a history of aplastic anaemia complained of poor control of her right arm and hand, unsteady gait, and headache that increased while in a recumbent position. She was diagnosed with cerebral sinus thrombosis. Additional investigation revealed paroxysmal nocturnal haemoglobinuria (PNH). Treatment with heparin was initiated but stopped after the patient developed a brain haemorrhage. The patient recovered with no signs of residual symptoms and began taking oral anticoagulants as maintenance therapy. PNH is a rare acquired clonal disorder due to a defective expression of the glycosylphosphatidyl-inositol anchor membrane protein. It is characterised by haemolytic anaemia, diminished haematopoiesis, increased susceptibility for infections and a hypercoagulable state. Patients with aplastic anaemia have an increased risk of developing PNH. In patients with cerebral sinus thrombosis PNH should be considered as a possible underlying disorder. These patients should be questioned for possible clinical symptoms of PNH, such as acute abdominal pain or dark urine in the morning. For patients with these symptoms and in those with a history of aplastic anaemia or recurrent thrombosis, additional testing for PNH should be conducted.

Adult↗
PubMedDate not supplied

Cavernous sinus thrombosis with Jacod's triad.

Presented is a rare case of cavernous sinus thrombosis of nasal septic origin leading to ophthalmoplegia and blindness of the ipsilateral eye and contralateral visual field involvement. An attempt is made to correlate the aetiopathology with the clinical features.

Adult↗
PubMed1994

Congenital protein C deficiency and superior sagittal sinus thrombosis causing isolated intracranial hypertension.

The first case of a superior sagittal sinus thrombosis causing isolated intracranial hypertension as a result of congenital protein C deficiency is reported. Such a possibility must not be overlooked. Anticoagulation is recommended as a treatment for cerebral venous thrombosis. In the case of congenital protein C deficiency, vitamin K antagonists must be started cautiously due to the risk of skin necrosis.

Cerebral Angiography↗
PubMed1995

[Otogenic sigmoid sinus thrombosis in the course of chronic otitis media].

A four cases of sigmoid sinus thrombosis due to chronic exacerbated otitis media were presented. In all patients surgical intervention involved a radical mastoidectomy and exposure of the sinus. In two cases sigmoid sinus was incised and the internal jugular vein ligated. In the two others, sinus was only needled. A high dosages of antibiotics were administered parenterally. All patients were discharged in good state of heals.

Adolescent↗
PubMed2003

A case of cerebral sinus thrombosis developed during a high-altitude expedition to Gasherbrum I.

We report a case of cerebral sinus thrombosis, which is a rare but serious complication that may develop during high-altitude climbing. A climber who reached the summit of Gasherbrum I (8068 m) suffered from motor weakness and gait disturbance as he descended from the peak. Within a few days, the symptoms progressed until he could not walk. Following a difficult and week-long rescue mission by his colleagues, he was hospitalized and diagnosed with thrombosis at the superior sagittal and right transverse sinuses. Climbers and rescuers should know the risk factors of this complication, such as hemoconcentration, procoagulability, and dehydration.

Adult↗
PubMed1988

Computed tomographic diagnosis of septic sinus thrombosis and their complications.

The authors report on five cases of septic sinus thrombosis occurring as early complications and/or long-term complications of infections in the head and neck region. The necessity for early diagnosis of this condition by high-resolution CT scanning is emphasized, as it provides a reliable diagnostic tool to evaluate this serious intracranial disease at a relatively early stage, provided an intravenous contrast medium is used. Although MRI represents an interesting new technique in the assessment of intracranial pathology, it cannot be routinely carried out during the acute phase of this condition due to metal life-support systems near the patient.

Adolescent↗
PubMed2006

Dural sinus thrombosis: frequency and imaging diagnosis.

OBJECTIVE: To determine the frequency of dural sinus thrombosis (DST) and highlight diagnostic importance of its subtle imaging findings in patients presenting for workup of their varied neurologic complaints and symptoms. STUDY DESIGN: Observational case series. STUDY PERIOD: June 2002- May 2005. PATIENTS AND METHODS: All new patients undergoing cranial computed tomography (CT) and magnetic resonance (MR) imaging were included in this study which consisted of 1676 consecutive subjects with 1780 examinations. These were reviewed in real time on monitors (as they were being performed) for evidence of DST before printing of hard copies prior to disposition of patients. CT studies were performed on Toshiba Auklet scanner with 5 mm thick axial slices and 1 cm inter slice gap. MR imaging was performed on 1.5 Tesla Toshiba Visart scanner with T1 and T2 weighted (T1 and T2W), spin echo, FLAIR and post contrast T1 weighted (T1W) imaging in multiple planes. Subjects with inconclusive but suspicious conventional imaging (CT, MR) were evaluated by magnetic resonance venography (MRV). Patients presenting for follow-up of established diagnoses including neoplasia, arterial infarcts, hypertensive parenchymal haemorrhages and postsurgical status were excluded. RESULTS: Delta and empty delta were the most commonly observed CT and MR signs diagnostic of DST on pre and postcontrast images and were present in 43 patients. Thrombus was also directly visible within lumen of superior sagittal, transverse and sigmoid sinuses on T1W MR images in 21 individuals. In 12 patients, these signs were either absent or too subtle to be conclusive. However, presence of venous haemorrhagic or non-haemorrhagic brain parenchymal edematous lesions prompted further evaluation by MRV, which confirmed presence of DST in these subjects as well. As a result, a total of 55 patients with a frequency of 3.3% were diagnosed and treated for DST. CONCLUSION: Frequency of DST in patients with neurological complaints and symptoms is 3.3%, which is significantly higher than has been clinically suspected or recognized. On routine CT and MR studies, diagnostic imaging signs, while highly specific for DST, can be absent or may be masked due to technical factors or associated complications. Presence of brain parenchymal venous haemorrhagic or non-haemorrhagic edematous lesions should prompt judicious and close scrutiny of images on monitors by changing viewing parameters to detect subtle signs of DST. If still in doubt, MRV must be pursued for definitive diagnosis.

Adolescent↗
PubMed2003

Management of lateral sinus thrombosis: update and literature review.

The management of four cases of lateral sinus thrombosis (LST) over a four-year period at the Royal Darwin Hospital is presented in this retrospective review. The patients were aboriginal and presented with otalgia, otorrhoea and sepsis. Two cases had an associated complication of an otitic hydrocephalus and a subperiosteal abscess. Cholesteatoma was found in three cases. Computed tomography (CT) scan confirmed the LST in three cases. Three patients were anaemic and thrombocytopenic. All patients had positive blood cultures. The organisms were predominantly mixed anaerobes and Bacteroides species. Three patients were managed surgically as a two-stage procedure. One patient was managed as a single-stage procedure with a modified radical mastoidectomy. Therapeutic anticoagulation was utilized in one case. There were no deaths. The prognosis of LST is good if treatment is instituted early with broad-spectrum intravenous antibiotics and surgery. The role of clot removal at surgery and the use of anticoagulation are discussed in this paper.

Adolescent↗
PubMed2005

Cigarette smoking and risk of cerebral sinus thrombosis in oral contraceptive users: a case-control study.

Idiopathic cerebral sinus thrombosis (CST) can cause death and serious neurological disability. It is unknown whether smoking, a major risk factor for arterial stroke, is a risk factor also for CST. This work explored the association between smoking and CST in a hospital-based, multicentric, case-control study. In order to avoid the confounding effect of the different risk factors for CST, we analysed the homogeneous subgroup of oral contraceptive users. We compared the prevalence of smoking in a group of 43 young women with CST (cases), whose oral contraceptive use was the only known risk factor, with a sample of 255 healthy contraceptive users of similar age (controls). The prevalence of smoking in cases and controls was similar (26% vs. 29%). The age and geographic area-adjusted odds ratio was 0.9; 95% confidence interval, 0.4-1.8; p=0.7. Smoking in oral contraceptive users does not appear to be associated with CST.

Adolescent↗
PubMed1990

Cerebral venous and sagittal sinus thrombosis after transcallosal removal of a colloid cyst of the third ventricle: case report.

The authors report a case of cortical vein and sagittal sinus thrombosis after a transcallosal removal of a colloid cyst of the third ventricle. Thirty-six hours after the operation, the patient developed focal seizures; after progressive deterioration, he died on the sixth postoperative day. At the autopsy, a venous hemorrhagic infarct in the right frontoparietal area and fresh thrombus occluding the sagittal sinus and cortical veins were found. The mechanism of cortical vein and sinus thrombosis subsequent to this procedure is discussed, and suggestions are made to prevent this serious complication.

Brain Diseases↗
PubMed2006

A quartet of lateral sinus thrombosis, extradural abscess, subdural abscess and occipital abscess: complications of acute mastoiditis in a pre-adolescent child.

Neurological complications of acute mastoiditis are rare but can be life threatening. Their presentation may be masked by the use of antibiotics. We present a unique case of acute otitis media progressing to occipital, extradural and subdural abscess formation and lateral sinus thrombosis in a child. The clinical course and management of a pre-adolescent male is presented and discussed. We review the incidence, presentation and treatment of occipital abscesses and lateral sinus thrombosis with acute mastoiditis. Following extended cortical mastoidectomy, neck exploration and broad spectrum intravenous antibiotics, the patient made a full recovery. This is the first reported case of acute mastoiditis associated with occipital abscess in a child. Early, aggressive treatment is required for a successful outcome. The rarity of neurological complications, in addition to the insidious onset and subtle symptoms associated with antibiotic therapy, can make diagnosis extremely difficult. Patients with acute otitis media who fail to respond fully to treatment should be referred early for a specialist otology opinion.

Acute Disease↗
PubMed2004

Cavernous sinus thrombosis presenting with diplopia in an allogeneic bone marrow transplant recipient.

Although neurological complications are common in patients undergoing allogeneic bone marrow transplant (alloBMT), cavernous sinus thrombosis (CST) has rarely been described. An allograft recipient is described who presented with diplopia and developed CST in the early post-transplant period likely caused by a filamentous fungus. Clinical course and serial radiological studies of this patient are described and correlated with autopsy findings.

Adult↗
PubMedDate not supplied

Transverse sinus thrombosis: an unusual cause of headache.

A 24-year-old woman presented with headache of 6 days' duration, described as throbbing pain in the right periorbital region radiating to her right ear and neck. The pain was unresponsive to oral analgesics. She had no speech or hearing difficulties, no previous history of migraines, and no family history of neurologic disease. Her medications included oral contraceptives for 8 months' duration. This report describes the salient features of dural sinus thrombosis and recent advances in diagnostic and therapeutic procedures. The relationship between oral contraceptives and protein S levels is also discussed. Cerebral dural sinus thrombosis should be considered in the differential of new onset of headaches, seizures, or focal neurological deficits.

Adult↗
PubMed1998

[Superior sagittal sinus thrombosis presenting with subarachnoid hemorrhage in a patient with aplastic anemia].

A 54-year-old female, who had been treated for aplastic anemia by metenolone acetate since 1981, developed a sudden unconsciousness in September 1995. On admission, she was drowny, CT showed a subarachnoid hemorrhage (SAH) in the right Sylvian fissure. Angiography demonstrated a complete occlusion of the superior sagittal sinus. The SAH was assumed to be originated from rupture of the right Sylvian vein, which was irregularly dilated on angiography. The dural sinus thrombosis was thought to be caused by a long term use of metenolone acetate, and it was discontinued. But her platelet count dropped due to the aggravation of aplastic anemia, and she developed repeated hemorrhagic infarction. An active anticoagulant therapy for the dural sinus thrombosis was thought to be inappropriate because she had the aplastic anemia and the hemorrhagic infarction recurred. We have successfully treated this case by mild anticoagulant therapy with nafamostat mesilate (Futhan).

Anemia, Aplastic↗
PubMed1991

[An unusual case of superior sagittal sinus thrombosis accompanied with dural AV fistula].

Benign intracranial hypertension or pseudotumor cerebri is an collective term for a number of diverse syndromes characterized by increased intracranial pressure. Neither intracranial mass nor ventricular dilatation is observed in this disorder. Moreover, the pathogenesis of this syndrome has yet to be determined. We report a case of 36-year-old female diagnosed as benign intracranial hypertension, who has developed superior sagittal sinus thrombosis and dural AV fistula during the follow up period. The patient was pointed out to have papilledema and elevated intracranial pressure six years ago. Although she was examined by both DSA and CT scan, no abnormal intracranial lesions were observed. Consequently, she was diagnosed as the benign intracranial hypertension and had been followed as an out patient. Three years later, lumboperitoneal shunting was performed because of severe headache and visual impairment. Postoperatively, the patient had been well for two years. Recently, occipital headache recurred and she was readmitted to our hospital. MRI studies demonstrated dilated vessels in the right occipital area. Additionally, angiograms revealed not only the superior sagittal sinus thrombosis but also the rich network of dural AV fistula adjacent to the occlusion. According to those results, the superior sagittal sinus was supposed to have the incomplete occlusion or delayed blood flow that were not observed by DSA, MRI and CT scan performed previously. Those occlusive change in the superior sagittal sinus impeded the CSF absorption and elevated the pressure of venous inflow, then the arterio-venous communication has been developed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗