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PubMed1993

Intracranial dural arteriovenous fistulas and sinus thrombosis. Report of five cases.

Dural arteriovenous fistula and sinus thrombosis are sometimes associated. The relationship between these two conditions remains unclear. Thrombophlebitis of the dural sinus may induce a dural fistula. Conversely, thrombophlebitis is sometimes observed in the course of dural fistulas. We report five cases of dural arteriovenous fistulas associated with sinus thrombosis. In three cases, the angiographic and pathological data indicated the responsibility of thrombosis in the occurrence of the fistula. In the others two cases, thrombophlebitis and fistula were simultaneously diagnosed by angiography. However, in one of these cases, the clinical data showed that the fistula probably was a causative factor in the occurrence of thrombophlebitis.

Adult↗
PubMed2006

Dural sinus thrombosis in melioidosis: the first case report.

Melioidosis which is infection with Burkholderia pseudomallei, is an important cause of sepsis in India, southeast Asia and northern Australia. Mortality is high and treatment is problematic. Neurological melioidosis is unusual but meningoencephalitis, encephalomyelitis and brain microabscess can occur Dural sinus thrombosis is not an uncommon cerebrovascular disorder with various etiologies. Hypercoagulable state, pregnancy, dehydration, certain blood dyscrasia and contraceptive pills are common causes however meningitis and local head & neck infections may lead to this condition. Dural sinus thrombosis complicating septicemic melioidosis has never been reported. The authors report a 42-year-old Thai man suffering from septicemic melioidosis with dural sinus thrombosis. He had high fever, headache, left hemiparesis, focal seizure and increased intracranial pressure. Diabetes and mild alcoholic cirrhosis were diagnosed in this admission. CT scan, MRI brain and MRV revealed superior saggital sinus thrombosis with complicating venous infarction over right posterior parietal lobe. Hemoculture demonstrated Burkholderia pseudomallei and CSF was acellular Investigations for causes of dural sinus thrombosis were all negative. This patient gradually improved after treatment with ceftazidime, antiepileptic drug and heparin without clinical recurrence. Neuromelioidosis is a rare syndrome that may present as brain abscess, encephalitis or meningoencephalitis. The authors report dural sinus thrombosis associated with septicemic melioidosis. The authors' hypothesis of venous thrombosis in the presented case is sepsis induced hypercoagulable state. Physicians should be aware of cerebral venous thrombosis in case of suspicious melioidosis with neurological involvement. Prompt treatment with intravenous heparin and antibiotic is potentially effective.

Adult↗
PubMed2001

Rheolytic catheter and thrombolysis of dural venous sinus thrombosis: a case series.

OBJECTIVE: The high morbidity and mortality rates associated with dural sinus thrombosis may be heightened by a delay in diagnosis, which necessitates prompt and effective treatment. Traditional treatment consists of the initiation of systemic anticoagulation with heparin and, more recently, regional thrombolysis with direct endovascular infusion of thrombolytic agents. We report our experience in a series of five patients in whom we accomplished mechanical clot lysis with the combination of a rheolytic device and balloon catheters. METHODS: Five patients with dural sinus thrombosis were treated with a combination of pharmacological and mechanical thrombolysis with the 5-French Angiolet rheolytic catheter (Possis Medical, Minneapolis, MN) and balloon catheters. The success of the procedure was determined by resolution of or improvement in the patient's neurological examination results and imaging features. RESULTS: All five patients demonstrated immediate improvement as observed on imaging studies or in terms of neurological status. Three patients required more than one intervention, and all but one patient continued to improve after the final intervention. Two of the five patients continued to experience mild residual neurological deficits, and two patients experienced complete recovery. The fifth patient had a delayed recurrence of thrombosis that required multiple interventions, and the patient has significant neurological deficits. Navigation of the dural sinuses was possible in all patients with the use of a microcatheter and was possible to a variable degree with the rheolytic catheter. Known complications of the procedures included two pseudoaneurysms at the femoral puncture site. CONCLUSION: Mechanical clot lysis is a powerful technique for immediate restoration of antegrade venous flow in dural sinus thrombosis. In most patients, the superior sagittal sinuses and contralateral transverse sinuses could be accessed with the 5-French rheolytic catheter.

Adult↗
PubMed1999

[The natural history of a dural arteriovenous fistula associated with sinus thrombosis: a case report].

The patient, a 52-year-old man, complained of vertigo. CT scan revealed right cerebellar infarction and he was admitted to our hospital. MRI revealed a fresh thrombus in the right transverse sinus and angiography revealed the occlusion of the right transverse-sigmoid sinus. He complained of vertigo again and he was re-admitted to our hospital 4 months after the first admission. Angiography revealed a dural arteriovenous fistula (DAVF) of the right transverse-sigmoid sinus fed by the right occipital artery and the right transverse-sigmoid sinus was found to be recanalized. The angiography which was carried out one year after the second admission, revealed also an enlarged DAVF fed by the left occipital artery and the right transverse sinus was occluded again. There are two theories about the pathogenesis of DAVF. One is that it is congenital and the other that it is acquired, but it is still controversial. Our case suggested that sinus thrombosis induced DAVF initially and the DAVF induced sinus thrombosis secondarily. The causal relations between DAVF and sinus thrombosis probably changed inversely over a long term and, when we discuss the pathogenesis of DAVF, we must understand the natural history of DAVF starting from the occurrence of sinus thrombosis.

Arteriovenous Fistula↗
PubMed1981

Superior sagittal sinus thrombosis diagnosed by computed tomography.

Superior sagittal sinus thrombosis is an often unrecognized clinical condition. This is due to its variable clinical presentation and its association with other serious disease states. The following cases demonstrate that, in the infant, thrombosis of the superior sagittal sinus can be diagnosed quickly and noninvasively by computed tomography (CT). In those clinical situations in which thrombosis of the superior sagittal sinus may occur and neurological changes exist, axial and coronal CT scans may be quite specific in detecting its occurrence.

Humans↗
PubMed1996

Cavernous sinus thrombosis following manipulation of fractured nasal bones.

Septic cavernous sinus thrombosis is a serious infective condition with a high mortality and morbidity. We report the first case to our knowledge of septic cavernous sinus thrombosis following manipulation of fractured nasal bone under general anaesthesia. The patient later developed complications of pneumonia with pleural effusion, a vegetative lesion of the mitral valve, and blindness.

Adult↗
PubMed2005

Sigmoid sinus thrombosis following mastoiditis: early diagnosis enhances good prognosis.

Sigmoid sinus thrombosis following mastoiditis is a rare, but potentially life-threatening, condition. Its treatment usually consists of systemic antibiotics and mastoidectomy. In this report, we describe a pediatric case of sigmoid sinus thrombosis following mastoiditis, presenting with nonspecific symptoms such as fever, otalgia, and headache. Diagnosis was based on magnetic resonance imaging. The patient responded very well to intravenous antibiotics with a rapid clinical improvement and complete recanalization of the thrombosed sigmoid sinus. In conclusion, mastoiditis may present few clinical symptoms. In case of treatment failure or new-onset neurologic deficit in children with acute otitis media, life-threatening complications associated with mastoiditis should be considered. Early diagnosis is important, as favorable prognosis can be achieved with conservative management without performing any surgical intervention.

Abducens Nerve Diseases↗
PubMed1996

Onset of neurologic deficits after treatment with dihydroergotamine in a patient with sagittal sinus thrombosis.

A woman with a 7-year history of intermittent migraine had 3 months of gradually worsening headaches. Initial neurologic examination including fundus examination was normal, and initial head computerized tomographic (CT) scan and magnetic resonance imaging (MRI) were thought to be normal. The patient was given dihydroergotamine (DHE-45), 1.0 mg, intravenously for relief of headache. Five hours later, she complained of severe diffuse headache and nausea. Neurologic examination showed left arm weakness and sensory loss, blurring of the left optic disc, and bilateral Babinski signs. Cerebral arteriography demonstrated thrombosis of the sagittal sinus, which in retrospect was present on the initial contrast CT scan and MRI scan. The patient's deficits worsened, and she eventually died 20 days later as a result of cerebral infarctions and increased intracranial pressure, despite attempts at selective thrombolysis of the sagittal sinus. DHE has potent venoconstrictive effects. We suspect that DHE helped precipitate neurologic deterioration in this patient with sagittal sinus thrombosis.

Adult↗
PubMed1994

Cavernous sinus thrombosis diagnostic approach.

We report three cases of cavernous sinus thrombosis and compare the values of three imaging methods: orbital phlebography, computerized tomography (CT) and magnetic resonance imaging (MRI). On the other hand, we performed 2D "time of flight" MRI flow sequences on a series of subjects with normal cavernous sinus. Visualization of cavernous veins in all subjects by this method makes it possible to consider using it for the diagnosis of undoubtedly cavernous sinus thrombosis in all safety. MRI-angiography, therefore, may replace orbital phlebography.

Adult↗
PubMed2003

[Occipital sinus as a potential differential diagnosis in patients suspect of dural sinus thrombosis--a case report].

INTRODUCTIONS: The diagnosis of dural sinus thrombosis despite of using modern imaging techniques still remains a difficult problem. For satisfactory interpretation of CT and MR scans it is indispensably important the knowledge of anatomical variations and possible imaging artifacts. One of the relatively rare developmental variations--giving chance for making false positive diagnosis--is the occipital sinus with hypoplasia or agenesis of transverse sinus. CASE REPORTS CONCLUSION: The incidence, the anatomical classification, the importance and the possibility of differentiation from sinus thrombosis are reviewed based on case reports of four patients.

Adult↗
PubMed1991

The role of sinus thrombosis in occipital dural arteriovenous malformations--development and spontaneous closure.

Two cases of dural arteriovenous malformations are presented. Both were associated with thrombosis of the sigmoid sinus. Without any treatment, recanalization of the sinus occurred in one case, while the dural arteriovenous malformation was persisting. In the second case, recanalization of the sinus coincided with the spontaneous closure of the malformation. The interrelationship of sinus thrombosis and dural arteriovenous malformations, and the possible mechanism of spontaneous closure are discussed.

Arteriovenous Fistula↗
PubMed1996

[Superior sagittal sinus thrombosis in children during the first year of life: clinical aspects, imaging and development].

BACKGROUND: Thrombosis of the intracranial sinuses and veins may be septic or aseptic, and in the latter case are often due to alteration in hemodynamics. It may also be seen in young babies without known predisposing factors. PATIENTS: From 1988 to 1994, 11 children had cerebral venous thrombosis (longitudinal sinus) in the first year of their life. Their ages ranged from two days to 11 months. Transient seizures, lethargy, pseudo tumor cerebri were the first clinical symptoms. The presence of longitudinal sinus thrombosis was suggested by unenhanced CT scan, confirmed by colour doppler flow imaging and magnetic resonance angiography, with absence of blood flow in the longitudinal sinus. Repeated doppler flow imaging showed thrombus resolution within 3 weeks. Thrombosis was associated with predisposing factors in seven cases and appeared idiopathic in the four others. CONCLUSION: Diagnosis of longitudinal sinus thrombosis can be made more accurately and noninvasively by colour doppler flow and angio-MRI. Treatment with anticoagulants appears unnecessary and dangerous in idiopathic forms.

Female↗
PubMed2000

MR angiographic diagnosis of cerebral venous sinus thrombosis following allogeneic bone marrow transplantation.

Allogeneic bone marrow transplantation is frequently associated with neurological complications, particularly intracerebral bleeds and infections. Cerebral venous sinus thrombosis has only rarely been reported following allogeneic transplants. We report three cases of cortical venous thrombosis following allografting for acute lymphoblastic leukaemia. Two patients received marrow from HLA-identical siblings and one from an unrelated donor. Two of the patients presented with grand mal seizures and one presented with a headache. No neurological abnormalities were found upon clinical examination and lumbar puncture was normal in all three cases. In two of the patients computed tomography (CT) of the brain was normal and in the third showed non-specific abnormalities. Magnetic resonance imaging (MRI) with MR angiography (MRA) demonstrated cerebral venous sinus thrombosis in all three patients. In conclusion, cerebral venous sinus thrombosis should be considered in the differential diagnosis when neurological symptoms occur following allogeneic bone marrow transplantation. We therefore advocate the use of MRA for unexplained neurological symptoms post-allograft since without it cerebral venous sinus thrombosis may easily be missed.

Adolescent↗
PubMed1989

[Transverse sinus thrombosis accompanied by intracerebellar hemorrhage: a case report].

This case report deals with transverse sinus thrombosis accompanied by intracerebellar hemorrhage. A 33-year-old woman had sudden onset of headache, vomiting, and disturbance of consciousness. Computed Tomography (CT) scan showed left intracerebellar hematoma, while vertebral angiography revealed no visualization of the transverse sinus and cerebellar cortical veins on the left side. Evacuation of the intracerebellar hematoma along with decompression of the posterior fossa was carried out. Findings of the histopathological examination of the operation specimen showed the cortical veins to be filled with fresh thrombus and softened cerebellar parenchyma mixed with many small clots. Until now, cases such as hemorrhagic infarction in the cerebellum, due to transverse sinus thrombosis have not yet been reported. It is considered that there is much more collateral circulation in the infratentorial region rather than in the supratentorial region. This indicates that cerebellum hemorrhagic infarction rarely occurs due to transverse sinus thrombosis. In our case, the inflammation of the cortical veins (thrombophlebitis) was thought to have disturbed the collateral circulation in the cerebellum.

Adult↗
PubMed2000

Sagittal sinus thrombosis associated with transient free protein S deficiency after L-asparaginase treatment: case report and review of the literature.

Cerebral sinus thrombosis associated with acquired free protein S deficiency is very rare. We report the case of an adult patient with acute lymphoblastic leukemia who presented with repeated transient ischemic attacks followed by a seizure during consolidation treatment with L-asparaginase. Magnetic resonance of the brain showed a small cortical hemorrhagic infarct. Superior sagittal sinus thrombosis was demonstrated by cerebral angiogram. A marked decrease of the free form of protein S was documented. One month later, when the patient was free of symptoms, the follow-up free protein S antigen level was restored to the normal range. We suggest that the sagittal sinus thrombosis in this patient was caused by acquired, transient free protein S deficiency. This case also extends the clinical spectrum of cerebral sinus thrombosis to include recurrent transient ischemic attacks alternating with seizures.

Adult↗
PubMed2005

Pediatric lateral sinus thrombosis: retrospective case series and literature review.

OBJECTIVE: A comparison between the literature and our management of pediatric patients presenting with otogenic lateral sinus thrombosis. DESIGN: A retrospective case series of five pediatric patients. SETTING: Four patients were treated at BC Children's Hospital, whereas the fifth patient was treated in New Westminster, BC. All were treated between 1994 and 2001. METHODS: A retrospective chart review was conducted with a literature review for otogenic lateral sinus thrombosis. MAIN OUTCOME MEASURES: Treatment success was based on resolution of acute infection and neurologic symptoms. RESULTS: Five patients, four males and one female, aged 2 to 14 years were reviewed. Three patients were treated successfully without mastoidectomy. One patient received a mastoidectomy that yielded no pus or granulation tissue within the mastoid cavity. One patient required a mastoidectomy after failure to respond to bilateral myringotomy and tympanostomy tube insertion. Although no pus was seen in the mastoid cavity, perisinus pus was found after unroofing the sigmoid sinus plate; free flow of blood was obtained on needle aspiration of the sinus, and the sinus was not surgically opened. CONCLUSION: The current literature states that the management of otogenic lateral sinus thrombosis includes high-dose intravenous antibiotics with a mastoidectomy and possible opening of the sinus. In our retrospective case series, three of five patients recovered completely without mastoidectomy, and a fourth had a mastoidectomy deemed to have been unnecessary. We conclude that intravenous antibiotics and insertion of a tympanostomy tube are sufficient treatment for selected cases of otogenic lateral sinus thrombosis. Mastoidectomy with possible opening of the sinus should be reserved for patients refractory to the above conservative treatment.

Adolescent↗
PubMed2005

Mechanical thrombolysis for treatment of acute sinus thrombosis--case report.

A 55-year-old woman presented with consciousness disorders. Computed tomography revealed hemorrhage in the left temporoparietal region. The angiographic diagnosis was progressive sinus thrombosis from the superior sagittal sinus to the bilateral transverse sinuses. Her condition deteriorated despite heparin administration. Therefore, mechanical thrombolysis was performed for sinus thrombosis using a balloon catheter, in addition to supportive thrombolytic therapy with urokinase, resulting in sinus patency. Mechanical thrombolysis is an effective therapeutic modality for sinus thrombosis refractory to heparin administration.

Catheterization↗