SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Lateral sinus thrombosis is a difficult diagnostic problem. Specialized computerized tomography allows non-invasive preoperative visualization of sinus contents enabling the surgeon to make a definitive diagnosis with appropriate preoperative planning. This case report details these specialized techniques and their application to a case of lateral sinus thrombosis.
Although it is rarely seen now, lateral sinus thrombosis may occur in either its septic or aseptic form. Septic lateral sinus thrombosis is a potentially fatal condition in which early diagnosis may be difficult because of previous antibiotic therapy. Once diagnosis is made, combined antibiotic and surgical treatment is necessary to keep the mortality rate at 25%. Aseptic lateral sinus thrombosis is a condition that is rarely fatal but that leads to symptoms of severe headache and visual impairment. The increased intracranial pressure is associated with a blockage of the dominant sinus (usually the right one). The decision to use medical treatment alone or to combine it with surgical treatment must depend on the clinical features of each case.
Sinus thrombosis, which causes pseudotumor cerebri, is difficult to diagnose with conventional imaging apparatus, CT and MRI. We report a case of sinus thrombosis due to Behçet's disease diagnosed by magnetic resonance angiography (MRA). A forty-five-year old man with severe headache and ocular pain was examined. Since he had a history of oral ulcers, genital ulcers, and erythema nodosum venous thrombosis, he had been diagnosed as having Behçet's disease previously. He showed marked papilledema bilaterally but no obvious intracranial lesion was observed by CT and MRI. On MRA, an obstruction was apparent at the sagittal sinus. Anticoagulant and steroid therapy were effective to relieve the headache, and to improve the constricted visual field temporarily. By MRA, blood flow was confirmed in the sagittal sinus. However, mild papilledema persisted and finally vision was lost because of optic atrophy.
OBJECTIVES: To define the contemporary management of septic otogenic lateral sinus thrombosis. STUDY DESIGN: Retrospective case series identified through database search of otologic surgical cases managed by a single surgeon in four teaching hospitals over a 6-year period. METHODS: Twelve patients presenting with lateral sinus thrombosis of otogenic cause were the subjects of this study. Patients with incomplete medical records or unknown outcomes were excluded. RESULTS: Lateral sinus thrombosis was the result of chronic otitis media in 50% of cases, with five of these patients having cholesteatoma. In addition, there were seven associated intracranial complications in six patients in this series. All patients underwent medical and surgical treatment. Aggressive and early surgical treatment was tailored to the degree of preoperative and intraoperative findings. The sigmoid sinus was resected in six of the patients with a variable degree of inferior margin proportional to the extent of thrombosis. Thrombectomy alone under vascular control with reestablishment of flow was used to remove the septic thrombus in the other six patients. There were no complications in these patients. CONCLUSION: Early and aggressive surgical intervention of this otogenic complication can potentially minimize mortality, hospital stay, and length of medical treatment.
Dural sinus thrombosis, a relatively rare disease, is difficult to diagnose because of variable symptomatic manifestations. We successfully treated a case of dural sinus thrombosis by direct thrombolysis using an endovascular technique in combination with postoperative anticoagulant therapy. The patient, a 19-year-old female, developed a headache affecting her whole head on December 13, 1993. She was admitted to our hospital the next day. Neurological examination upon admission revealed no neurological abnormalities, nor was there any abnormality in CT scan, either plain or enhanced, taken on the day of admission. The patient's consciousness deteriorated in the early morning of December 22. MRI and cerebral angiography revealed thrombi from the confluence of the sinuses to the right transverse and sigmoid sinus, with disturbed circulation through deep cerebral veins. Systemic thrombolytics, steroid and mannitol were started, but, on the next day, the third ventricle was compressed by bilateral swelling of the basal ganglia, with hydrocephalus. Since her consciousness deteriorated further despite ventricular drainage and barbiturate therapy, direct thrombolytic therapy was performed on December 25. A catheter was placed in the superior sagittal sinus, and 600,000 units of urokinase was locally injected, followed by postoperative anticoagulant therapy. The patient's condition improved rapidly. On CT scan, the bilateral swelling of the basal ganglia disappeared along with the hydrocephalus. At about 1 month after endovascular surgery, MRI and cerebral angiography revealed recanalization of the deep cerebral veins, straight sinus and confluence of sinuses with improved opacification of the left transverse sinus, although the right transverse sinus was found to be re-occluded.(ABSTRACT TRUNCATED AT 250 WORDS)
Dural sinus thrombosis has not been described in a patient with hypernatremia resulting from lithium-induced nephrogenic diabetes insipidus. A 63-year-old man on chronic lithium therapy for schizoaffective disorder was transferred to the Emergency Department with dehydration and signs of central nervous system dysfunction after a 3-week isolation in a room in a psychiatric hospital due to exacerbation of psychiatric disorder, during which he refused to eat. Laboratory examination revealed hypertonic hypernatremia (osmolality, 359 mOsm/kg and Na, 171 mEq/L) and hyposthenuria (specific gravity, 1.010 and osmolality, 249 mOsm/kg), with normal serum endogenous vasopressin concentration (2.3 pg/mL). The serum lithium concentration was within the therapeutic range (0.94 mEq/L). Cranial computed tomography demonstrated subarachnoid hemorrhage and suggested dural sinus thrombosis. Although treatment with indomethacin (25 mg parenterally at 8-hour intervals) was somewhat effective in restoring renal concentrating capacity, he died of massive hemorrhagic infarction on the sixth hospital day, probably secondary to dural sinus thrombosis. The clinical diagnosis was confirmed by postmortem examination. Physicians should be alert for the possibility of dural sinus thrombosis as a complication of hypernatremia resulting from lithium-induced nephrogenic diabetes insipidus.
Cerebral sinus thrombosis associated with protein S deficiency is rare to the best of our knowledge. We report here a 22-year-old female who presented sudden onset of headache, vomiting and disturbance of consciousness. Neuroradiological studies including computed tomography scan, magnetic resonance imaging and cerebral angiography disclosed a huge cerebral sinus thrombosis in the territory of the superior sagittal sinus, torcular herophili, lateral sinus and straight sinus. Hematological studies confirmed the diagnosis of protein S deficiency. We summarize the reported cases of cerebral sinus thrombosis associated with protein S deficiency. For young patients presenting occlusive cerebrovascular disease, we stressed the importance of doing extensive hematological investigation to detect possible etiological factors, such as protein S deficiency, protein C deficiency, antithrombin III deficiency. Once we discover the etiology of a disease, we may be able to designate the precise treatment or regimen for each patient.
Intracranial venous magnetic resonance angiography (MRA) provides excellent visualization of dural venous sinuses and large deep and superficial cerebral veins noninvasively. It is a very useful imaging technique to evaluate venous sinus thrombosis. It also provides the planning and monitoring endovascular thrombolytic treatment for dural sinus thrombosis. Familiarization with normal intracranial venous anatomy and its normal variants as well as recognition of its pitfalls and artifacts of the venous MRA techniques are critical for making interpretation of venous sinus thrombosis correctly.
PURPOSE: In autopsy reports of patients who died of septic cavernous sinus thrombosis, tributary venosinus occlusion has been a common finding related to intracranial inflammatory complications. The purpose of this article is to illustrate the MR and CT appearance of septic cavernous sinus thrombosis and tributary venous occlusion. METHODS: Over a period of 7 years, eight patients with septic cavernous sinus thrombosis were examined by contrast-enhanced thin-section CT. The CT scans of these eight patients and those of 30 healthy control subjects were assessed independently and subjectively by two blinded readers to ascertain the presence, size, and density of areas of nonopacification within the cavernous sinus and the presence of filling defects and dilation of tributary veins and venous sinuses. In six subjects, MR images supplemented by a contrast-enhanced spoiled gradient-recalled acquisition in the steady state (SPGR) sequence were assessed with respect to the presence of filling defects, expansion, and signal abnormalities within the cavernous sinus and tributary veins and sinuses. The MR and CT findings were compared. RESULTS: The CT studies of the eight patients were consistently differentiated from those of the control subjects by the two readers. Contrast-enhanced CT findings in patients included areas of nonopacification that were present within the cavernous sinus bilaterally in six cases and unilaterally in two. The size of the filling defects exceeded 7 mm in 76% of thrombosed cavernous sinuses compared with 9% of control subjects. The mean density of filling defects in patients differed significantly from those in control subjects. Comparison of the MR and CT findings in six cases showed the contrast-enhanced SPGR sequence to be equivalent to CT with respect to delineation of filling defects. CONCLUSION: Contrast-enhanced high-resolution CT findings indicate that venosinus thrombosis associated with septic cavernous sinus thrombosis is not restricted to the superior ophthalmic vein and is more common than previously assumed. A contrast-enhanced SPGR MR sequence may be used as a reliable alternative to establish the diagnosis of cavernous sinus and tributary venosinus thrombosis.
A patient with sinus thrombosis and characteristic magnetic resonance imaging (MRI) findings, who was managed successfully by barbiturate therapy is reported. MRI showed massive high intensity lesions on T2-weighted image which indicated venous cerebral infarction and brain oedema. Intravenous infusion of thiopental decreased increased intracranial pressure (ICP). The effectiveness of barbiturate therapy is discussed in terms of the similarity between this case and experimental sinus thrombosis. Barbiturate therapy should be considered in cases of severe sinus thrombosis with elevated ICP.
Spontaneous cerebral venous sinus thrombosis is a rare problem that may be encountered in patients with underlying thrombophilic disorders. It has also been reported as a postoperative complication following suboccipital, transpetrosal, and transcallosal approaches. The authors report on a 67-year-old man with two prior episodes of lower-extremity deep venous thrombosis who underwent transcallosal resection of a colloid cyst and in whom sagittal sinus thrombosis developed 2 weeks thereafter. Results of a subsequent hematological workup revealed both a factor V Leiden mutation and the presence of antiphospholipid antibodies, two thrombophilic risk factors that likely contributed to the development of delayed postoperative sinus thrombosis. Although the safety of low-molecular-weight heparin (LMWH) after craniotomy has not been established in a randomized, controlled study, there is sufficient evidence to justify its use for prophylactic anticoagulation therapy in patients at high risk for postoperative cerebral venous thrombosis. The authors propose using LMWH prophylaxis in patients with thrombophilic disorders who undergo neurosurgical procedures in proximity to dural sinuses in an effort to prevent catastrophic venous infarction.
The great variability of clinical appearance is one of the main features of superior sagittal sinus thrombosis. However, hydrocephalus associated with cerebral sinus thrombosis is rare. We report on a patient presented with thunderclap headache, accompanied by nausea, vomiting, and drowsiness. Lumbar puncture ruled out subarachnoid hemorrhage, whereas CT revealed marked hydrocephalus. In addition, magnetic resonance venography then confirmed the diagnosis of cerebral sinus thrombosis. It is a rare occurrence but clinically important, since it entails disastrous sequels if unrecognized, and hydrocephalus is treated in the usual fashion with ventricular drainage.
BACKGROUND: Cerebral venous sinus thrombosis is rare and can be promoted by various conditions. We report the case of cerebral venous thrombosis in a patient using androgens. CASE DESCRIPTION: A 31-year-old man using androgens for bodybuilding was admitted for headache and vomiting. He had cerebral venous sinus thrombosis, but extensive examinations did not reveal any known cause. CONCLUSIONS: We suggest that androgens may promote cerebral venous thrombosis. The mechanisms of venous thrombosis related to androgens may be platelet activation or an increase in coagulation factors. Because androgen use may be frequent and hidden in athletes, it may be an underestimated cause of cerebral venous sinus thrombosis in the young.
The incidence of both lateral and cavernous sinus thrombophlebitis has been significantly reduced in the antibiotic era. Since septic cavernous sinus thrombosis (CST) is mainly a complication of facial abscesses and septic lateral sinus thrombosis (LST) is almost invariably due to chronic otitis media, both conditions are of clinical relevance to the otolaryngologist. The predominant bacterium in septic CST is Staphylococcus aureus whereas in septic LST the bacteriology is very similar to that found in chronic otitis media. The diagnosis of septic CST can be established in most cases after thorough clinical examination, and contrast computerized tomography (CT) using the coronal projection usually confirms the clinical diagnosis. The signs and clinical course of septic LST are non-specific and the final diagnosis rests upon radiological investigations including CT-scan. The treatment of both conditions consists of broad-spectrum antibiotics, including beta-lactamase resistant penicillin in cases of septic CST. Most cases of septic LST also require surgical intervention. Two cases of septic intracranial sinus thrombosis are presented. The need for early diagnosis and treatment of this potentially lethal condition is emphasized.
OBJECTIVE: To describe the etiologies, clinical features and diagnosis of cerebral venous sinus thrombosis. METHODS: We reviewed the records of 23 patients admitted with a documented diagnosis of cerebral venous sinus thrombosis from 1991 through 1999 in the Beijing Tiantan Hospital. RESULTS: Infection was the major condition associated with cerebral venous sinus thrombosis. Pseudotumor cerebri syndrome was the most common manifestation, while hemiplegia, seizure and unconsciousness may occur alone or in association. The diagnostic sensitivity of computed tomography (CT), magnetic resonance imaging (MRI) and digital subtract angiography (DSA) were 59%, 86% and 100%, respectively. The sensitivity of MRI with magnetic resonance angiography (MRA) reached 96%. CONCLUSION: As the clinical findings were found to be nonspecific, CT combined with DSA, or MRI with MRA turns out to be valuable for the early diagnosis of cerebral venous sinus thrombosis.
Thrombosis of the cerebral venous sinuses is characterized by clinical pleomorphism and variable pathogenesis. Although there is a relationship with pregnancy and especially with the puerperium, occurrence during the first trimester of pregnancy is unusual and this may effect the diagnosis and treatment. We describe the case of a 33 years-old patient with lateral sinus thrombosis in the first trimester of pregnancy. This was diagnosed and followed-up by magnetic resonance. Investigations as to its aetiology were inconclusive and it followed a benign course without anticoagulation. Thrombosis of the venous sinuses has been found empirically to be related to states of deficiency of S protein, hypercoagulability, anaemia and deshydration during pregnancy, to having previously taken contraceptive pills. Behçet's disease, other coagulopathies, central or systemic vasculitis, collagen disorders, septic and neoplastic disorders and a large number of cases of unknown aetiology. In our patient neurological deterioration secondary to a venous infarct or intraparenchymatous haemorrhage was not seen. There was full recovery and complete spontaneous canalization of the sinus, as shown on posterior cranial angiography. The controversial decision to use heparin in thrombosis of the cerebral venous sinuses should probably depend on the possible risks and benefits in each individual case, taking into account the clinical findings, aetiology and topography of the thrombosed sinus.
Cerebral venous sinus thrombosis is a condition that is well documented as a complication of the latter stages of pregnancy and with an even greater incidence during the puerperium. More recently this entity had been associated with the use of oral contraceptives. A case is presented of a 15-year-old girl with this condition, in whom the occurrence as well as the resolution of a superior sagittal sinus thrombosis was demonstrated with serial computed tomography (CT) scans and radionuclide studies. The discussion of this case, coupled with a review of the literature, describes the clinical presentation, explores the possible etiology, offers a noninvasive technique for confirming the diagnosis, and presents the medical management of this condition. It is postulated that cerebral venous sinus thrombosis occurs with a greater frequency than is currently recognized. Health professionals involved with monitoring the health care of adolescents during pregnancy and in the puerperium should be aware of this potential complications. In addition, association of this condition with oral contraceptive use should be recognized.
BACKGROUND: Cerebral dural sinus thrombosis is a rare clinical entity. Symptoms may be vague, and left untreated thrombus progression may be fatal because of venous congestion and infarction. METHODS: We report a case of post-traumatic dural sinus thrombosis treated with selective transfemoral, transvenous catheterization and infusion of urokinase. RESULTS: Urokinase infusion into the dural venous sinuses using a microcatheter introduced from the femoral vein was successfully carried out, and patency of the venous sinuses was reestablished. CONCLUSION: Venous sinus thrombosis can be an overlooked sequel to head injury. If the diagnosis is entertained, prompt performance of appropriate imaging studies should be instituted so that therapy can be initiated. The use of selective sinus catheterization using microcatheter techniques with instillation of urokinase is an excellent mode of therapy that should be considered in any patient with symptomatic occlusion.