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PubMedDate not supplied

Superior sagittal sinus thrombosis in neonates.

Three neonatal patients with superior sagittal sinus thrombosis are reported. The neurologic signs were bulging of the anterior fontanel and clonic hemi-convulsions. Neonatal polycythemia was believed to be an etiologic factor in two patients. Computed tomography revealed massive edema with slit-like ventricles in two patients. Increased density of the torcular Herophili and straight sinus also were demonstrated in two patients. The diagnosis of superior sagittal sinus thrombosis was confirmed by cerebral angiography in one patient and by digital subtraction angiography in the other two patients. Digital subtraction angiography appears to offer a definite advantage in the diagnosis of cerebral sinus thrombosis in the neonatal period.

Cerebral Angiography↗

PubMed1999

Management of lateral sinus thrombosis.

OBJECTIVES: Review the clinical signs and symptoms, management, bacteriology and outcomes of patients treated for lateral sinus thrombosis. STUDY DESIGN: A retrospective review of six patients, treated from 1993 through 1998, with an intraoperatively confirmed diagnosis of lateral sinus thrombosis. METHODS: All charts from 1993 through 1998 coded for sinus thrombosis, meningitis, brain abscess, otitic hydrocephalus, subdural abscess, and mastoidectomy were reviewed. Operative reports, radiological examinations, laboratory data, culture data and other pertinent data were reviewed. RESULTS: The presenting symptoms ranged from headache to mental status changes. All patients had a history of chronic ear disease and all had at least one additional intracranial complication. The range of additional intracranial complications included otitic hydrocephalus, epidural abscess, and brain abscess. All of the infections were polymicrobial, with a predominance of anaerobes. There were no mortalities; morbidities included anacusis, acute respiratory distress syndrome, reoperation, seizures, septic cardiomyopathy, transfusion, ventriculoperitoneal shunt and nutritional supplementation. CONCLUSION: In patients with otologic disease, complaints of headache, earache or photophobia should warrant an evaluation. The presence of lateral sinus thrombosis mandates further investigation for additional intracranial complications. Conservative surgical intervention, consisting of removal of all perisinus infection and needle aspiration of the sinus, has been found to be effective. Lateral sinus thrombosis is an uncommon complication of otitis media, with potentially significant morbidities, necessitating a high index of suspicion.

Adolescent↗

PubMed2006

[Association of Bezold's abscess and sigmoid sinus thrombosis. A case report].

Bezold's abscess and sigmoid sinus thrombosis are both classic complications of otitis media. However, since the introduction of antibiotics both have become very rare. Very few cases of these complications occurring concomitantly have been reported. We describe the clinical case of a 45 year old male with a 10 year history of neglected right ear cholesteatoma. The patient presented to our department with a 10 day history of purulent right otorrhea, otalgia, increasing headach, pyrexia and suppurating right parapharyngeal mass. CT scan confirmed right middle ear cholesteatoma associated with ipsilateral Bezold abscess and and sigmoid sinus thrombosis. Treatment was by mastoidectomy, broad spectrum intravenous antibiotics and anticoagulation. The patient made a full uncomplicated recovery. The association between chronic middle ear disease, sigmoid sinus thrombosis and Bezold abscess are discussed.

Abscess↗

PubMed2005

Coronary angiojet catheterization for the management of dural venous sinus thrombosis. Technical note.

In most cases of deep venous sinus thrombosis, systemic anticoagulation represents the initial treatment of choice for preventing propagation of a clot in the dural sinuses. In patients with deep or extensive venous sinus thrombosis, a combination of treatment modalities may be required including systemic anticoagulation, selective venous thrombolysis, and mechanical thrombectomy. In the current study the authors report on a patient who presented with the acute onset of headache, vomiting, a depressed level of consciousness, and a left hemiparesis and in whom a right middle cerebral artery (MCA) territory ischemic stroke with hemorrhagic conversion was initially diagnosed. Results of diagnostic cerebral angiography demonstrated a patent right MCA and a deep venous sinus thrombosis involving most of the dural sinuses. Despite adequate systemic heparinization, the patient's neurological condition deteriorated and direct administration of alteplase into the transverse sinus in conjunction with mechanical clot disruption using a coronary AngioJet was required. Venous flow was successfully reestablished in the deep and superficial venous sinuses by using a 0.014-in exchange wire routed from the right common femoral vein through the sinuses and out the left common femoral vein. Excellent angiographic results were obtained, and the patient had recovered completely by the 7-month follow up.

Adult↗

PubMed1999

Emergent decompressive craniectomy in patients with fixed dilated pupils due to cerebral venous and dural sinus thrombosis: report of three cases.

OBJECTIVE AND IMPORTANCE: Cerebral venous and dural sinus thrombosis is a rare cause of stroke. Although morbidity and mortality have greatly decreased in recent years as a result of early diagnosis and timely medical treatment, when coma occurs the prognosis remains poor. We evaluated whether emergent decompressive craniectomy has a role in the treatment of patients with brain herniation from dural sinus thrombosis and hemorrhagic infarct. CLINICAL PRESENTATION: Three patients developed large hemorrhagic infarct with coma and bilaterally fixed and dilated pupils resulting from aseptic dural sinus thrombosis. INTERVENTION: Two patients underwent emergent surgical decompression as soon as brain herniation developed, and these patients had complete functional recovery. One underwent delayed surgical decompression and remained severely disabled. CONCLUSION: Our results provide preliminary evidence that emergent decompressive craniectomy is effective in patients with brain herniation from dural sinus thrombosis, provided that the clinical onset is recent. We therefore recommend consideration of this aggressive surgical technique for such patients, who may survive with good outcomes.

Adult↗

PubMed1994

Superior sagittal sinus thrombosis in a patient with acquired immunodeficiency syndrome.

A 41-year-old man with acquired immunodeficiency syndrome was admitted to the hospital because of a recent onset of disorientation and memory loss. He developed focal neurologic signs on hospital day 4, and a computed tomographic scan of his head showed a right medial temporal lobe hyperdensity. Before diagnosis could be made or treatment started, the patient was unexpectedly found dead on hospital day 14. At autopsy, a primary central nervous system B-cell immunoblastic lymphoma was found involving both hippocampi and other periventricular areas. Associated angiodestruction and necrosis with local vascular thrombosis were seen. In addition, there was extensive, partial thrombosis of the superior sagittal sinus and distal superficial cortical veins unassociated with cerebral hemorrhage or infarction, lymphoma, or involvement with opportunistic organisms. Retrospective review of radiographic studies demonstrated the classic "empty delta" sign. To our knowledge, cerebral venous and dural sinus thrombosis has not been well documented in patients with the acquired immunodeficiency syndrome. Because the dural venous sinuses are not routinely examined at autopsy in many institutions, cerebral venous/dural sinus thrombosis in patients with the acquired immunodeficiency syndrome may be more frequent than is presently recognized.

Acquired Immunodeficiency Syndrome↗

PubMed1988

The role of anticoagulation in cavernous sinus thrombosis.

Prior to the antibiotic (AB) era, cavernous sinus thrombosis (CST) was almost uniformly fatal. AB therapy has significantly reduced mortality, but additional treatment with anticoagulants (AC) has remained controversial. We reviewed our experience with seven cases, as well as the literature since Lyons' 1941 introduction of AC treatment, to determine effectiveness, complications, and morbidity among survivors. We divided the cases into (1) those treated with AB alone, and (2) those treated with a combination of AB and AC. We found no conclusive evidence for reduction of mortality when AC was used in combination with AB. However, early AC therapy reduced morbidity (blindness, stroke, ophthalmoplegia, hypopituitarism, focal seizures, and vascular steal syndrome), whereas delayed or inadequate use provided no apparent benefit above AB therapy alone. Complications of AC therapy were rare; cerebral venous thrombosis occurred frequently, but in association with dural sinus thrombosis as a direct result of the disease. We conclude that AC therapy is indicated early in the treatment of CST to reduce morbidity among survivors.

Adolescent↗

PubMed1985

Superior sagittal sinus thrombosis associated with Evans' syndrome of haemolytic anaemia.

A case of superior sagittal sinus thrombosis associated with Evans' syndrome of immune haemolytic anaemia is reported. The neurological symptoms and signs were headaches, right quadrant hemianopia, dyslexia without agraphia, motor aphasia, numbness in and weakness of the right upper extremity, papilloedema and coma. The cerebral venous sinus thrombosis, involving cerebral veins, superior sagittal sinus and straight sinus, was diagnosed by cerebral angiography. It is noteworthy that the superior sagittal sinus thrombosis occurred during a haematological recovery period, with rapid responses to treatment with 6-mercaptopurine and high doses of adrenocorticosteroids. Following a reduction in the doses of these drugs, the symptoms and signs related to the superior sagittal sinus thrombosis gradually subsided, and the haematological pictures remained in remission.

Adult↗

PubMed1994

Primary empty sella in association with superior sagittal sinus thrombosis and dural arteriovenous malformation. Case report.

A 61-year-old woman under treatment with oral medroxyprogesterone acetate following surgery for breast cancer developed diplopia and papilledema due to raised intracranial pressure (ICP). Radiological studies disclosed an empty sella turcica, a dural arteriovenous malformation (AVM), and superior sagittal sinus thrombosis. The sinus thrombosis was considered to have been a side effect of the medroxyprogesterone acetate medication. The association between a primary empty sella and raised ICP is briefly discussed, along with the cause-and-effect relationship between a dural AVM and venous sinus thrombosis.

Arteriovenous Malformations↗

PubMed1993

Sigmoid sinus thrombosis after closed head injury in children.

In the literature, clinical descriptions of sigmoid sinus thrombosis occurring after closed head injury in children are rare. One to 5 days after trauma to the back of the head, five children (aged 1 to 7 yr) presented with gait ataxia, vomiting, and headache. Trauma was mild in four children. Computed tomography of all the children, performed within 5 days after the injury, showed focal hyperdensity in the region of the left sigmoid sinus. Four children had extra-axial hyperdense collections along the left transverse sinus, and three had skull fractures adjacent to the left sigmoid sinus. Magnetic resonance imaging (MRI) of all the children, performed 2 to 6 days after injury, showed left sigmoid-sinus thrombosis and decreased flow or thrombosis within the lateral third of the left transverse sinus. All the children had MRI scans 4 to 6 weeks after their diagnosis and were followed up for 1 to 12 months. In four children whose symptoms subsided completely within 2 to 10 weeks, MRI showed recanalization of the sigmoid sinus within 4 to 6 weeks after injury. In one child whose symptoms resolved after 6 months, sigmoid-sinus thrombosis persisted with the formation of collateral flow. We conclude that traumatic sigmoid-sinus thrombosis should be suspected when a child has persistent or delayed gait ataxia and vomiting after injury to the back of the head. Computed tomography characteristically demonstrated focal hyperdensity within the sigmoid sinus that we term the dense sigmoid-sinus sign. Because the sinus recanalized and the symptoms subsided in most children within 6 weeks, we conclude that prophylactic medical or surgical intervention is not indicated.

Child↗

PubMed1991

Early hypopituitarism following cavernous sinus thrombosis: total recovery within 1 year.

Hypopituitarism related to cavernous sinus thrombosis is a very rare event which usually occurs at least 1 year after the acute stage. We report a case which distinguished itself from the previously reported cases through (i) its occurrence during the acute stage and (ii) its total recovery within 1 year. Early anterior hypopituitarism is probably more frequent than expected on the basis of reported cases and it may contribute to the high rate of mortality in cavernous sinus thrombosis. This underscores the need to consider hypopituitarism in every patient with cavernous sinus thrombosis.

Adult↗

PubMed1993

The management of lateral sinus thrombosis.

The standard recommended treatment for lateral sinus thrombosis is intravenous antibiotics. For those that fail, some authors recommend anticoagulant therapy, others internal jugular vein ligation. Despite these recommendations, there is still a significant mortality in all reported large series and the main reason this is that the cause of the failure has not been found or investigated. Over a six-year-period, from January 1985 to December 1990, 36 patients were admitted with lateral sinus thrombosis. The initial treatment consisted of intravenous antibiotics and surgery. The surgery included cortical mastoidectomy for non-cholesteatomatous ears and modified radical mastoidectomy for cholesteatomatous ears and drainage of the intracranial collection of pus in patients with subdural empyema and brain abscess. There were nine failures (25 per cent) with this treatment regimen. Blood cultures and pus swab of the ears were taken from these patients. The blood cultures were positive in four patients and the organisms isolated included beta-haemolytic Streptococcus sp. in two, Proteus mirabilis and Streptococcus pneumoniae in one each. From the ear swab mixed cultures were found in eight and a single organism in one. Gram-negative organisms were isolated in nine (100 per cent), Proteus mirabilis in eight (89 per cent) and Enterobacter sp. in two. Both these organisms were resistant to ampicillin and penicillin but were sensitive to amikacin. Amikacin was then added to the treatment regimen and a dramatic response with a fall in the temperature, and improvement in the patients' general condition was noted within 24 hours, in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2000

Posttraumatic dural sinus thrombosis in children.

Posttraumatic dural sinus thrombosis (DST) in children has rarely been described in the literature. Over a period of two years (1994-1996) we treated 131 children (n=131) with minor or severe head injury requiring a cranial computed tomography (CT) scan. DST was found in eight patients (6.1%), five with mild and three with severe cranial trauma. Diagnosis was suspected either because of a skull fracture crossing over a dural sinus or because of a hyperdensity at a dural sinus in the noncontrast CT scan. Enhanced CT scan was used to confirm DST. No specific symptoms related to DST were observed. DST was managed conservatively in all patients and recovery was uneventful. Recanalization of the sinus was documented to occur within three weeks to six months in six children. One patient showed a residual clot after five months and another did not have a follow-up CT scan. Based on our data we conclude that neither surgical nor medical intervention is indicated in traumatic DST in children.

Adolescent↗

PubMed2006

[Transient ischemic attack: the only presenting syndrome of dural sinus thrombosis].

INTRODUCTION: Intracranial hypertension (ICHT) is the most frequent presenting syndrome of dural vein sinus thrombosis (CVT). A transient ischemic attack as an acute mode of onset is exceptional. CASE REPORT: A right handed, forty years old man with a medical history of recurrent headaches, microcephalia and calcifications in his brain, presenting to the emergency department with left paresis that lasted a few minutes and with a complete recovery. The cerebral and neck magnetic resonance (MR) including MR angiography showed superior sagittal sinus, both transverse sinuses and right sigmoid sinus thrombosis with an increase in size of superficial cerebral venous that drained to the left sigmoid sinus. There was no evidence of intracranial dural malformations. The cerebral MR did not show any abnormal parenchymal enhancement (edema, arterial or venous infarctions, hemorrhage) including diffusion-weighted IMR. The digital subtraction angiography (ADC) confirmed the same findings as the MR angiography. The diagnosis was a chronic CVT. We studied stroke in a young adult and we did not find other irregularities. The neurological examination was normal when the patient left the hospital with an antiplatelet drug. CONCLUSIONS: Focal neurological deficit is an exceptional event of a chronic vein sinus thrombosis during follow-up. Isolated cases regarding an acute time course have been described. The interest of this case lies in the fact that venous sinus thrombosis rarely has transitory focal deficit in its course and we found no such description as onset symptoms.

Adult↗

PubMed2006

Cerebral venous sinus thrombosis in neonates.

Neonatal Cerebrovenous sinus thrombosis(CVST) is extremely rare, however it is a devastating condition and one needs to be aware of this condition to diagnose it. The risk factors for CVST are still not properly understood. The largest registry for stroke and for neonatal CVST is from the Canadian registry which quotes an incidence of 0.6 per 100,000 population per year. No data is present for the neonatal CVST in this region. One needs to be aware of this devastating condition to manage it timely and appropriately. To date there is no consensus on the role of anticoagulant therapy and therefore therapy is largely supportive, however individual cases have to be evaluated and treated on merit.

Cerebral Veins↗

PubMed1990

Computerized tomography in dural sinus thrombosis.

The incidence of dural sinus thrombosis (DST) appears to be on the rise. This is most probably due to an increased awareness as well as the earlier detection by computerized tomography (CT). Computerized tomography has emerged as the radiological screening procedure of choice and may in fact be the only investigation necessary. The CT scans should be done without and with contrast enhancement. A number of signs have been described; some are pathognomonic while others are nonspecific. As CT is relatively noninvasive, follow up scans at appropriate intervals can be done in patients suspected of having DST. CT can also aid in the understanding of its evolution and can prognosticate its outcome. Angiography is only reserved for a selected few where diagnosis proves difficult. We report our experience of 13 patients with DST.

Adult↗

PubMed2004

Long-term prognosis of cerebral venous sinus thrombosis in childhood.

Cerebral venous sinus thrombosis (CVST) is a rare but potentially serious disorder in children. There is no literature on the long-term neuropsychological and emotional sequelae and implications for quality of life. We studied 17 children who had CVST after the neonatal period, aged between 1 month and 16 years at the time of CVST (mean age at CVST was 6 years, median 4 years 8 months). Five children died during follow-up. The cause of death was related to CVST in one child. Twelve children participated in a clinical follow-up assessment. Mean follow-up was 2 years 8 months. One child had physical sequelae with impairment of skilled movement. All children had average or high intelligence scores. Two children with CVST due to an uncomplicated mastoiditis had mild cognitive deficits: one child had difficulty with written language; the other had diminished cognitive efficiency with concentration and attention problems associated with decreased psychosocial functioning. Decreased physical well-being was reported in three of 12 children. We conclude that children who had survived CVST had a fair prognosis. Most had normal cognitive and physical development, although mild cognitive deficits or decreased physical and psychosocial well-being can occur.

Adolescent↗

PubMed2006

Thrombophilic gene polymorphisms in puerperal cerebral veno-sinus thrombosis.

Puerperal cerebral veno-sinus thrombosis (PCVT) is a common form of stroke in young women in India, which is associated with high morbidity and mortality. The frequency of PCVT in India is 10 to 12 times more compared to western population. As yet, the etiology of this condition is unclear. Our aim was to study the prevalence and the role of the common genetic polymorphisms associated with thrombophilia such as factor V Leiden, prothrombin G20210A and methylene tetrahydrofolate reductase (MTHFR) C677T, in aseptic PCVT. We investigated 86 women with PCVT and 86 age-matched women with no post-partum complications. Polymerase chain reaction (PCR)/restriction fragment length polymorphism analysis was used to identify their genotypes. The frequency of the three polymorphisms in cases and controls were: factor V Leiden, 2.3% versus 1.2% (OR 0.49, 95% CI=0.02-7.12, p=1.000) and MTHFR C677T, 16.3% versus 17.4% (OR 0.92, 95% CI=0.39-2.19, p=0.838). The prothrombin G20210A variant was not detected in either patients or controls. The clinical characteristics of the PCVT patients with the polymorphisms did not differ significantly from those without them. In our series of PCVT patients, the risk associated with the established thrombophilic risk factors is insignificant. Exploration of these gene polymorphisms seems to be of limited value in the investigation of PCVT in south Indian women.

Adolescent↗