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PubMed1995

Doppler imaging of superior sagittal sinus thrombosis.

Three cases of neonatal superior sagittal sinus thrombosis diagnosed by Doppler imaging and confirmed with either computed tomography, magnetic resonance imaging, or digital subtraction angiography are described. One infant died and the others had uneventful recovery. Young infants with superior sagittal sinus thrombosis rarely are seen for diagnostic imaging; the nonspecificity of the clinical presentation of this disorder and the difficulties with its investigation owing to the invasiveness of the radiologic procedures lead to its underdiagnosis. Magnetic resonance imaging is a sensitive, noninvasive diagnostic modality, but it is not always available and practical for the very sick infants in the critical care unit. In the cases described here, Doppler imaging proved to be diagnostic and useful in the management of superior sagittal sinus thrombosis and should be used in the initial assessment of the condition, as it is the most convenient and least traumatic diagnostic modality.

Angiography, Digital Subtraction↗
PubMed2004

A transcranial approach for direct mechanical thrombectomy of dural sinus thrombosis. Report of two cases.

Cerebral venous sinus thrombosis is often difficult to manage. Treatment options include systemically delivered anticoagulation therapy or chemical thrombolysis. Targeted endovascular delivery of thrombolytic agents is currently a popular option, but it carries an increased risk of hemorrhage. These strategies require significant time to produce thrombolysis, often in a patient with a rapidly deteriorating neurological condition. Rapid mechanical recanalization with thrombectomy is therefore very attractive; this procedure provides rapid recanalization with no increased risk of hemorrhage from use of thrombolytic agents. Nevertheless, the rheolytic catheter is large and stiff and may not be able to navigate tortuous intracranial vascular anatomy. The authors present their experience with direct dural sinus mechanical thrombectomy performed using the rheolytic catheter via a transcranial route. Two patients with dural sinus thrombosis and rapidly deteriorating levels of consciousness underwent unsuccessful attempts at mechanical thrombolysis via the usual transfemoral route. Through a burr hole over the dural sinus, mechanical thrombectomy was subsequently performed using the thrombectomy catheter. Sinus patency was restored following treatment and both patients demonstrated neurological recovery. Hemorrhage or a rapidly deteriorating neurological condition may preclude the use of systemic or locally delivered thrombolytic agents for the treatment of cerebral venous sinus thrombosis. Mechanical thrombectomy may be the treatment of choice in these circumstances. In patients with limited transfemoral access, a transcranial approach may be used to access the cerebral dural sinuses and thrombectomy may be safely and effectively performed. Further evaluation of this therapy is warranted.

Catheterization↗
PubMed1997

Nonseptic lateral sinus thrombosis: the otolaryngologic perspective.

Nonseptic lateral sinus thrombosis (NSLST) differs from septic lateral thrombosis (SLST) in that it is not associated with ear or sinus infection, it usually occurs in the adult population, and it has an ambiguous clinical presentation. The otolaryngologist is often consulted about diagnostic findings associated with lateral sinus thrombosis. We report three cases of NSLST that required otolaryngologic assessment. The patients were women, ages 23 to 31 years. Presenting symptoms were headaches in all three patients; one also had concomitant ear pain. Two patients had negative head computed tomography scans; only magnetic resonance imaging was diagnostic. Treatment of NSLST consists of anticoagulation and elimination of predisposing factors. Familiarity with this condition is fundamental for early diagnosis and initiation of appropriate therapy. We discuss the origins and causes of NSLST, clinical presentation, preferred diagnostic strategy, and treatment alternatives.

Adult↗
PubMedDate not supplied

[Ophthalmological manifestations of cavernous sinus thrombosis].

Thrombosis of cavernous sinus is one of the most grave diseases of cerebral venous system; its first signs most often manifest in the organ of vision. Pain in the orbit and the respective half of the head develop in the presence of general fatigue, chill, and fever. In parallel with this, venous dyscirculatory disorders in the eye and its appendages involve all oculomotor nerves in succession. Further progress of the disease leads to development of congestive optic disk. Involvement of the other eye is one of the most severe complications of cavernous sinus thrombosis. Further course and manifestations depend on 3 factors: premorbid status, location of the focus of infection, and routes of its penetration into cavernous sinus.

Adult↗
PubMed1995

Transcranial color-coded real-time sonography of intracranial veins. Normal values of blood flow velocities and findings in superior sagittal sinus thrombosis.

Sonographic findings in patients with superior sagittal sinus thrombosis were compared to those in healthy adults. Two patients with angiographically verified superior sagittal sinus thrombosis were examined by transcranial color-coded real-time sonography (TCCS) after intravenous application of a pulmonary stable ultrasound contrast agent. For comparison, 10 patients without venous pathology had contrast-enhanced TCCS; in addition, 30 healthy adults had plain TCCS to determine the identification rate for deep and superficial venous segments and to define normal values of venous blood flow velocities. The straight sinus was identified in 22 of 30 healthy subjects by plain TCCS, and in 9 of 10 patients by contrast-enhanced TCCS. The mean peak and angle-corrected blood flow velocity was 19.1 +/- 7.1 cm/sec. The superior and inferior sagittal sinuses were identified by contrast-enhanced TCCS in 2 and 1 subjects, respectively; they were never seen on plain TCCS. In the 2 patients with sagittal sinus thrombosis a distinct increase of blood flow velocity was recorded from the straight sinus (83 and 92 cm/sec), most likely reflecting collateral circulation. These preliminary data indicate that TCCS and particularly contrast-enhanced TCCS permit identification and blood flow measurements within the deep and occasionally, the superficial venous system. TCCS may contribute to an assessment of hemodynamic repercussions of venous thrombosis and may indicate the risk of venous infarction and hemorrhage.

Adult↗
PubMed2003

[Cerebral sinus thrombosis in Behçet disease: case report and review of the literature].

BACKGROUND: Behçet's disease is a chronic inflammatory disorder, clinically characterised by multisystemic vasculitis. Primary neurologic involvement in childhood is quite exceptional. We report a case of a child with recurrent venous thrombosis of the dural sinus. Behçet's disease was diagnosed. HISTORY AND SIGNS: A 13-year-old boy from Eritrea was referred to our clinic with severe headaches and photophobia one month after onset. Ophthalmological examination disclosed a bilateral papilledema. Recurrent oral ulcers and pseudo-folliculitis were present. Pathergy test was positive. THERAPY AND OUTCOME: Complementary investigations disclosed an inflammatory syndrome. Computertomography was normal. Cranial magnetic resonance venography disclosed multiple cerebral sinus thrombosis (superior sagittal sinus, sigmoid sinus and lateral left sinus). There was no evidence of infectious, inflammatory or hypercoagulation disorder. A Behçet's disease was diagnosed based on the medical history and clinical examination. Whilst his general health deteriorated rapidly before treatment, he improved quickly after the onset of therapy with immunosuppression (Prednisone and Ciclosporine) in combination with anticoagulation (coumarin/Sintrom). CONCLUSION: Behçet's disease is uncommon and difficult to diagnose in children. Neurologic involvement as a first presentation is rarely described, but might be underestimated. We emphasise, therefore, the systematic application of magnetic resonance venography in children with unclear persistent headaches.

Adolescent↗
PubMed2001

Sigmoid sinus thrombosis: an old foe revisited.

Sigmoid sinus thrombosis (SST) has become increasingly uncommon. In the pre-antibiotic era this condition had a mortality rate of over 90%.1 A high index of suspicion is required to make the diagnosis. We present a rare case of sigmoid sinus thrombosis secondary to mastoiditis, which illustrates the problems of delayed diagnosis. This report highlights the importance of rapid diagnosis and early surgical intervention. We emphasis the need for scanning and otolaryngology referral in all cases of middle ear disease associated with pain or vertigo which does not resolve rapidly on appropriate antibiotic therapy.

Adolescent↗
PubMed1984

Dural sinus thrombosis in paroxysmal nocturnal hemoglobinuria.

Dural sinus thrombosis developed in a young man with paroxysmal nocturnal hemoglobinuria (PNH). His neurological disorder developed in the face of anemia and a urinary tract infection. Progressive neurological deterioration occurred in spite of anticoagulation, antibiotic and steroid therapy. The propensity to develop cerebral vein and sinus thrombosis in PNH may be due to release of thromboplastin material from hemolyzed red blood cells, the interaction of complement with red blood cells and platelets, or from increased sensitivity to platelet aggregation.

Adult↗
PubMed1982

Complications of mastoiditis with special emphasis on venous sinus thrombosis.

Two children with intracranial venous sinus thrombosis complicating mastoiditis prompted review of the experience with these disorders at the The Children's Memorial Hospital in Chicago over the past decade. Fifteen patients, 1.5 to 14 years of age, with mastoiditis were identified, including nine cases categorized as acute and six as chronic, the latter without fever but with chronic otorrhea. All six patients with chronic, but none with acute, mastoiditis were found to have cholesteatomas. Venous sinus thrombosis developed in four children and intracerebellar abscess in one child. Contrast-enhanced computerized tomography has proved valuable in the diagnosis of these rare, serious complications of mastoiditis in recent patients. Arteriography is still desired to confirm venous patency or occlusion prior to surgery because of well-documented developmental variations in venous drainage patterns. Optimal therapy of mastoiditis and its complications generally requires surgical drainage in addition to administration of antibiotics.

Adolescent↗
PubMed2002

Otogenic sigmoid sinus thrombosis: what is the role of anticoagulation?

OBJECTIVES: The treatment of otogenic sigmoid sinus thrombosis with surgery and antibiotics is well established. However, the role of anticoagulation remains unstudied. The study reviews the signs, symptoms, radiological evaluation, surgical treatment, and medical management of patients with otogenic sigmoid sinus thrombosis treated with or without anticoagulation. STUDY DESIGN: Retrospective review of nine patients from 1995 to 2001 with sigmoid sinus thrombosis. METHODS: Patients were identified by a review of all medical and radiological records. Signs, symptoms, diagnostic studies, treatments, and outcomes were recorded. In addition, telephone follow-up was performed. RESULTS Nine patients were identified over a 6-year period from 1995 to 2001. Patients had a mean follow-up time of 9 months (range, 1-24 mo). Of the nine patients identified, eight patients (89%) had tympanostomy tube placement, six patients (67%) had canal wall intact mastoidectomy, and one patient (11%) had canal wall down mastoidectomy. Needle aspiration of the sinus was performed in four of nine patients (44%), and incision of the sinus in two of nine (22%). Treatment with broad-spectrum antibiotics occurred in all patients with a mean duration of 12 days (range, 2-22 d) intravenously and 7 days (range, 0-21 d) orally. Sixty-seven percent of patients (six of nine) were anticoagulated: Five patients received low-molecular-weight heparin, and one patient received heparin-coumadin. No mortality occurred in either the anticoagulated or non-anticoagulated group. One anticoagulated patient did have persistent headaches and otorrhea. CONCLUSIONS: Surgery and antibiotic therapy are the cornerstones of the management of otogenic sigmoid sinus thrombosis. However, the role of anticoagulation remains unclear. Because complications of embolization and persistent sepsis are low in otogenic sigmoid sinus thrombosis patients treated with or without anticoagulation, withholding anticoagulation in selected patients is reasonable. Serial imaging to monitor for thrombus progression is advisable.

Anticoagulants↗
PubMedDate not supplied

[Superior sagittal sinus thrombosis in anti-phospholipid syndrome].

Authors show the case of the 16 old years patient who was admitted to the hospital with symptoms of rise intracranial pressure sign as pseudotumor cerebri. The cause of those symptoms was thrombosis of sinus sagitalis superior confirmed by MR. Clinical analysis and immunological examination gave a diagnosis of secondary antiphospholipid syndrome in the course of Systemic Lupus Erythematosus (SLE).

Adolescent↗
PubMed1994

Dural sinus thrombosis: value of venous MR angiography for diagnosis and follow-up.

OBJECTIVE: The purpose of this study was to determine the value of venous MR angiography as the sole procedure for the diagnosis and follow-up of dural sinus thrombosis. MATERIALS AND METHODS: Forty-two patients with clinical findings suggestive of dural sinus thrombosis were examined with venous MR angiography and spin-echo MR imaging. Maximum-intensity-projection reconstructions and individual sections of the MR angiograms were examined for direct and indirect signs of dural sinus thrombosis by assessing flow signal from the major sinuses, the jugular bulb, upper jugular veins, ascending cortical veins (occlusion or increased flow due to formation of collaterals), diploe (emissary) veins and extracranial veins, and the deep subcortical veins (Galen's and internal cerebral veins). Direct signs of dural sinus thrombosis on MR angiograms included lack of typical high flow signal from a sinus that did not appear aplastic or hypoplastic on single sections from MR angiography and the frayed appearance of the flow signal from a sinus after recanalization. Indirect signs of dural sinus thrombosis included evidence of formation of collaterals, unusually prominent flow signal from deeper medullary veins, cerebral hemorrhage, visualization of emissary veins, and signs of increased intracranial pressure. When available, conventional angiograms were evaluated by analogous criteria as appropriate. Digital subtraction or cut-film angiograms were available for correlation in nine patients. In nine patients, MR angiography was repeated up to eight times during the course of follow-up. The results of MR angiography for all patients were compared with results in 10 control subjects. Confirmation of the diagnosis of dural sinus thrombosis was based either on conventional angiographic findings or on the changes seen in follow-up examinations. RESULTS: Dural sinus thrombosis could be ruled out in 25 of the 42 patients on the basis of clinical and MR angiographic findings. In 17 patients with MR angiographic findings that indicated dural sinus thrombosis, conventional angiography confirmed the diagnosis in nine patients, and changes seen on repeat MR angiograms during follow-up confirmed the diagnosis in nine patients as well (one patient's diagnosis was confirmed by both techniques). Individual frames from two-dimensional fast low-angle shot sequences allowed direct visualization of thrombus. Limited spin-echo sequences as performed here provided inconsistent findings and were insufficient for diagnosis. In the 10 control subjects, attenuation of flow signal was seen in the torcular Herophili in all studies; one subject had a nonpathologic variant of the sinojugular system. CONCLUSION: MR angiography is the technique of choice for diagnostic evaluation and follow-up of dural sinus thrombosis, and it is reliable as the sole examination for this condition. When MR angiographic findings are unremarkable and other abnormalities must be ruled out, routine spin-echo MR imaging should be performed.

Adult↗
PubMed1995

Superior sagittal sinus thrombosis and thyrotoxicosis. Possible association in two cases.

BACKGROUND: Superior sagittal sinus thrombosis is an uncommon cerebrovascular accident that is frequently associated with diseases that may contribute to the development of thrombosis through hypercoagulability, stasis of the local blood stream, and abnormalities of the vessel wall. In approximately 25% of cases underlying diseases remain unrecognized. CASE DESCRIPTIONS: Two patients with superior sagittal sinus thrombosis during a thyrotoxic phase of Graves' disease are described. Both patients presented with hemiplegia, seizures, and a large goiter. CONCLUSIONS: The development of superior sagittal sinus thrombosis is multifactorial. Patients with thyrotoxicosis and a large goiter may be predisposed to the development of superior sagittal sinus thrombosis through hypercoagulability and stasis of the local venous blood flow.

Adult↗
PubMed1999

Spontaneous dural sinus thrombosis in children.

The clinical course of spontaneous dural sinus thrombosis in children varies from indolent to fulminant. Although many different etiologies for the development of dural sinus thrombosis have been described, a full recovery can be anticipated in most children following rehydration and the administration of systemic antibiotics. Steroids, systemic anticoagulation and intrasinus thrombolysis may be beneficial in selected patients, although the efficacy of these therapies has not been established prospectively in children. We reviewed 12 pediatric patients with spontaneous dural sinus thrombosis (1978-1998) to determine the etiology, clinical course and best treatment options. In the absence of a hypercoagulable state, pediatric patients generally recover well with rehydration and antibiotics and do not require anticoagulation.

Adolescent↗
PubMed2006

Spontaneous resolution of prenatally diagnosed dural sinus thrombosis: a case report.

Fetal thrombosis of the dural sinus is an extremely rare congenital cerebrovascular condition that is potentially fatal. We report a case of dural sinus thrombosis diagnosed by prenatal ultrasonography and fetal magnetic resonance imaging (MRI) in the second trimester. The thrombosis showed partial resolution during pregnancy and resolved spontaneously after birth without neurological complications. This is the first report of spontaneous postnatal resolution, and may provide helpful information on the natural history and prenatal counseling of fetal thrombosis of the dural sinus.

Adult↗
PubMed2002

Hypointense thrombus on T2-weighted MR imaging: a potential pitfall in the diagnosis of dural sinus thrombosis.

PURPOSE: To determine the frequency of hypointense appearance of dural sinus thrombosis on T2-weighted images, which may mimic a normal flow void, and when possible correlate with appearance on T1-weighted images. METHODS AND MATERIALS: Retrospective review of radiology files showed 51 patients with a discharge diagnosis of dural sinus thrombosis who underwent MR imaging during the period 1986-1998. These images were reviewed by an experienced neuroradiologist for appearance on T2-weighted images. This process yielded five cases in which a hypointense appearance on this pulse sequence simulated a normal flow void. An additional two cases were added from the teaching files of two other institutions giving a total of seven cases (13% of studies). The resulting study population consisted of five women and two men (mean age 27.1 years). T1 weighted images were available in five patients. In two patients MR venography was available, but not T1-weighted images. The diagnosis of dural sinus thrombosis was based solely on absence of flow void on T1-weighted images in one case, solely on absence of flow void on MR venography in two cases and absence of flow void on T1-weighted images in conjunction with MR venography or gradient echo findings in 4 patients. All images were obtained on a 1.5 T magnet (GE Medical Systems; Milwaukee, Wisconsin). RESULTS: In all patients hypointense signal of thrombus was isointense with normal flow voids in other dural sinuses on T2-weighted images. In all cases in which T1-weighted images were available, the signal intensity of thrombus was isointense to gray matter. CONCLUSION: Hypointense appearance of thrombus on T2-weighted images is a potential pitfall in the MR diagnosis of dural sinus thrombosis. Because thrombus in this stage of evolution appears isointense to gray matter on T1-weighted images, careful attention must be paid to other sequences to avoid this pitfall.

Adolescent↗