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PubMed2005

Dural sinus thrombosis after minor head injury in a child.

INTRODUCTION: Dural sinus thrombosis following minor head injury is rare. We report such a case in a child after mild head injury. CLINICAL PICTURE: A 4-year-old child presented with giddiness and vomiting after a fall. Clinical examination was unremarkable. Magnetic resonance venogram revealed thrombosis of the right sigmoid and transverse sinuses. TREATMENT: The patient was managed conservatively. OUTCOME: Repeat scans 10 weeks after injury showed recanalisation of the thrombosis. CONCLUSION: Dural sinus thrombosis should be excluded in children presenting with persistent giddiness and vomiting after minor head injury.

Child, Preschool↗
PubMed1989

Cerebral sinus thrombosis in patients with severe iron deficiency anaemia due to myoma uteri.

Two middle-aged women with haemorrhagic infarction due to thrombosis of the superior sagittal and transverse sinus, respectively, are herein reported. Severe iron deficiency anaemia secondary to myoma uteri seen in these patients was suggested to play a significant role in the development of the sinus thrombosis. In middle-aged women, myoma uteri deserves special attention as a possible aetiological contributor to cerebral sinus thrombosis.

Anemia, Hypochromic↗
PubMed1998

Dural sinus thrombosis associated with activated protein C resistance: MR imaging findings and proband identification.

OBJECTIVE: The purpose of this study was to report the association of dural sinus thrombosis with a hypercoagulable state associated with activated protein C resistance. CONCLUSION: In our small study population, hemorrhagic venous infarction was common (three of four patients) among patients with dural sinus thrombosis and activated protein C resistance. Four of five patients with dural sinus thrombosis had positive tests for activated protein C resistance. This finding, in conjunction with data from other studies, suggests that patients with dural sinus thrombosis may need to be studied for the presence of activated protein C resistance. A positive finding for activated protein C resistance can be important not only in helping to explain the cause of thrombosis in affected individuals but also in identifying families at risk for thrombosis.

Adult↗
PubMed1993

[Superior sagittal sinus thrombosis in paroxysmal nocturnal hemoglobinuria--an autopsied case].

A 43-year-old Japanese man was admitted to our hospital because of acute occipital headache and drowsiness. He had been diagnosed as paroxysmal nocturnal hemoglobinuria (PNH) with acute renal failure for 2 months prior to the admission. He had abdominal pain and fever of unknown origin for 2 weeks. On admission neurological examination revealed mild disturbance of consciousness, right papilledema and minimal nuchal rigidity. The urinalysis was normal and blood hemoglobin was 8.3 g/dl. Mild hemolysis was suspected because of decreased level of the serum haptoglobin. The magnetic resonance imaging (MRI) of the brain demonstrated the complete occlusion of the superior sagittal sinus by fresh thrombus and the cerebral hemorrhage in the right parieto-occipital subcortex. No other cause for cerebral sinus thrombosis was detected. The patient was treated medically using anti-edema agents, but on the twentieth hospital day he died because of brain herniation. The postmortem examination disclosed thrombosis in the superior sagittal sinus and transverse sinus on both side. There was a massive hematoma in the right parieto-occipital subcortex. The spleen and kidney also contained multiple venous thromboses. Twelve cases of cerebral sinus thrombosis with PNH have been reported in the literatures. Although cerebral sinus thrombosis is a common complication with PNH in Caucasian, but is rare in Asian including Japanese. This may probably depend upon a racial difference. To our knowledge, this is the first report of a patient with cerebral sinus thrombosis with PNH in Japan.

Adult↗
PubMed2001

The importance of venous hypertension in the formation of dural arteriovenous fistulas: a case report of multiple fistulas remote from sinus thrombosis.

Various hypotheses have been reported concerning the pathogenesis of dural arteriovenous fistulas (DAVFs). However, it is still controversial whether sinus thrombosis or venous hypertension has a greater influence on the formation of DAVFs. We present a rare case of multiple DAVFs that developed after sinus thrombosis. Chronic venous hypertension secondary to sinus thrombosis in the left transverse-sigmoid sinus induced the multiple DAVFs, including one in the right cavernous sinus, which was remote from the occluded sinus. This case indicates the importance of venous hypertension in the formation of DAVFs.

Central Nervous System Vascular Malformations↗
PubMed2000

Fatal cerebral venous sinus thrombosis as major complication of metastatic cervical mass: computed tomography and magnetic resonance findings.

Cerebral venous sinus thrombosis is an uncommon but potentially lethal condition, with mortality between 5.5-30 per cent. It was previously associated with infections of the orbit, mastoid or face, but, after the advent of antibiotics, the most common causes include neoplasms, dehydration, oral contraceptives, coagulopathies, collagen diseases, and pregnancy and the puerperium. We report a case of fatal cerebral venous sinus thrombosis in a 68-year-old patient with a metastatic cervical mass, who developed internal jugular vein thrombosis that progressed cranially to transverse and sagittal sinus thrombosis.

Aged↗
PubMed1977

Superior Sagittal Sinus Thrombosis.

Seven patients had superior sagittal sinus thrombosis diagnosed by cerebral arteriography. We recommend that anticoagulants not be used in the therapy of this entity, but rather that one should rely on antiedematous agents and anticonvulsants.

Adult↗
PubMed1999

Dural sinus thrombosis in a patient with protein S deficiency--case report.

A 23-year-old female presented with dural sinus thrombosis caused by protein S deficiency. She suffered superior sagittal sinus thrombosis 6 days after delivering her first child. Past history showed deep vein thrombosis at the age of 20. While conservative management was initiated because of the potential risk of increasing intracranial hemorrhage, several hours later she deteriorated rapidly because of severe brain swelling with massive hemorrhage. The patient died despite surgical decompression. Autopsy disclosed organized thrombus in the superior sagittal and transverse sinuses. Although the total concentration of protein S was normal, the free protein S concentration and protein S activity were decreased. Protein S deficiency is a rare cause of dural sinus thrombosis, but is associated with a high mortality rate, so accurate diagnosis and urgent intervention are required.

Adult↗
PubMed1991

Superior sagittal sinus thrombosis.

Seven cases of superior sagittal sinus thrombosis seen at Royal Prince Alfred Hospital over the 10 year period 1979 to 1989 have been reviewed. Diagnosis was confirmed by angiography, CT scan or autopsy. The average age was 33 years (16 to 47 years). Five of the patients were female and 2 male. On CT scan the 'empty delta' sign, present in 4 cases, was the most specific diagnostic feature. The underlying causes included primary thrombocythaemia, homocystinuria, post-angiographic investigation of an arteriovenous malformation, and oral contraceptives. In 2 cases no cause was found. Headache was the commonest and earliest symptom, being followed in frequency by convulsions and hemiparesis. Hemiparesis was the commonest sign observed, followed by papilloedema, cranial nerve palsies and impaired level of consciousness. Five of the patients developed signs and symptoms of raised intracranial pressure prior to the appearance of focal neurological deficits, mostly likely due to propagation of the thrombosis to cortical veins. There have been no controlled trials of therapy; however it is important to treat raised intracranial pressure rapidly and effectively, and although the role of anticoagulants remains controversial, their early use may be indicated when there is no radiological evidence of haemorrhage.

Adolescent↗
PubMed1998

Venous transcranial Doppler in acute dural sinus thrombosis.

The value of conventional transcranial Doppler ultrasound in the diagnosis and monitoring of cerebral vein thrombosis is unclear. Previous studies have suggested the usefulness of this method in two cases with superior sagittal sinus thrombosis that showed increased velocities of deep cerebral veins. The purpose of the present study was to evaluate the deep intracranial venous circulation in patients with that pathology. Venous transcranial Doppler ultrasound was performed with a range-gated 2 MHz transducer in 17 healthy volunteers and in six cases of proven acute superior sagittal sinus thrombosis. Peak systolic, end diastolic and mean blood flow velocities were measured in the basal vein of Rosenthal (BVR) and deep middle cerebral vein (DMCV) through a posterior temporal window. In 16 controls and in one patient, the straight sinus was also studied through an occipital approach. Sex distribution and mean age of controls and patients were similar. Mean blood flow velocities in controls were as follows (mean, SD): DMCV, 10.4, 1.4 cm/s; BVR, 11.3, 1.8 cm/s; straight sinus, 29.5, 9.9 cm/s. Three of the patients with superior sagittal sinus thrombosis showed increased velocities either in the DMCV, the BVR or the straight sinus. One patient showed slightly increased velocities in the BVR, and the other two showed normal venous velocity values. This study confirms the usefulness of conventional transcranial Doppler ultrasound in detecting superior sagittal sinus thrombosis. However, a normal examination does not exclude this diagnosis.

Adult↗
PubMedDate not supplied

Computed tomography of dural sinus thrombosis.

The four patients presented here demonstrate the value of contrast enhanced CT in the diagnosis and serial evaluation of dural sinus thrombosis. Two patients were young women using oral contraceptives; another patient had lateral sinus thrombosis complicating mastoiditis; a fourth patient developed superior sagittal sinus thrombosis following hip surgery. Improvements in CT diagnosis, including the use of thin sections for evaluation of the deep venous structures and lateral sinuses complemented by multiplanar reconstruction or direct coronal scanning, are discussed. Sequential scans for following the progress of two patients treated by barbiturate coma added to the understanding of dural sinus occlusive disease.

Adult↗
PubMed2003

A rare and serious complication of chronic otitis media: lateral sinus thrombosis.

Before the antibiotic era, lateral sinus thrombosis (LST) was the most frequent complication of otitis media. With the widespread usage of antibiotics, its occurrence is rare. Nevertheless, it is still a major complication of middle ear disease. LST mortality fluctuates between 5 and 35%. The major clinical symptoms of patients with LST are pain in the mastoid region, spiking fever, anemia and general health disorders. Computed tomography, magnetic resonance imaging and angiography are the most helpful in diagnosis, but the final diagnosis is made by surgical exploration. Three cases with LST are presented, and signs, diagnosis and treatment of disease are discussed.

Adult↗
PubMed1997

Venous microembolic signals detected in patients with cerebral sinus thrombosis.

BACKGROUND AND PURPOSE: We sought to assess the usefulness of the Doppler technique in the monitoring of microembolic signals in the main venous outflow pathways in superior sagittal sinus thrombosis. METHODS: Transcranial Doppler ultrasound was performed with a range-gated 2-MHz transducer in 6 patients with superior sagittal sinus thrombosis, in 5 subjects with platelet hyperaggregability, and in 20 healthy volunteers. Emboli monitoring was performed mainly in one distal internal jugular vein for 10 to 15 minutes. RESULTS: Three of the six patients (50%) with superior sagittal sinus thrombosis had microemboli. None of the patients with platelet hyperaggregation or healthy volunteers revealed microemboli. CONCLUSIONS: Microemboli can be found in superior sagittal sinus thrombosis by Doppler ultrasound. Their prognostic significance remains to be determined.

Adult↗
PubMed2006

[Effects of injecting urokinase via carotid artery in treatment of cerebral venous sinus thrombosis: an experiment with rabbit models].

OBJECTIVE: To study the effects of injection of urokinase via carotid artery in treatment of cerebral venous sinus thrombosis. METHODS: Thirty-nine New Zealand white rabbits were made into models of cerebral venous sinus thrombosis with the superior sagittal sinus ligated and injected with suspension of cephalin kaolin and cephalin, and then were randomly divided into three groups: control group (n = 15), anticoagulation group (n = 12, infused with heparin 2 mgxkg(-1)xd(-1) via external carotid venous for 5 days), and thrombolysis group (n = 12, injected with urokinase 4000 Uxkg(-1)xd(-1) via carotid artery for 5 days). Laser Doppler scanning was used to determine the local cerebral blood flow before ligation, 20 and 90 min after ligation, and at the end of experiment. Five rabbits of the control group per each of the 3 time points (before ligation, 12 h after ligation, and at the end of experiment) were killed to collect the tissues of cerebral cortex in front of the ligated part to determine the brain water content. All the remaining rabbits were killed within 24 hours after the end of experiment to determine the brain water content and undergo microscopy. RESULTS: The local cerebral blood flow of the thrombolysis group was 94.8% +/- 0.3%, significantly higher than those of the anticoagulation group (88.6% +/- 0.3%) and control group (80.9% +/- 0.3%) (both P < 0.01). The brain water content of the thrombolysis group was 78.9% +/- 0.3%, significantly lower than those of the anticoagulation group (81.8% +/- 0.7%) and control group (82.1% +/- 1.0%) (both P < 0.05). CONCLUSION: Improving the local blood flow and reducing the brain water content, injection of urokinase via carotid artery is effective in treatment of cerebral venous sinus thrombosis.

Animals↗
PubMed2004

Distinguishing dural sinus thrombosis from benign intracranial hypertension.

Dural sinus thrombosis (DST) is a life threatening illness and is often overlooked but it must be considered in the differential diagnosis of a patient presenting with a significant headache. DST presents similarly to benign intracranial hypertension (BIH) with intracranial hypertension and headache. A case of a 23 year old woman with DST is described that was initially diagnosed as BIH. A Medline search to determine the examination of a patient with suspected BIH or DST yielded several articles on this topic but only two brief case reports in the emergency medicine literature. Any patient with suspected DST or BIH must have a confirmatory magnetic resonance imaging and magnetic resonance venography study. Treatment of DST seems to be effective, considerably different from BIH, and lack of treatment may lead to increased morbidity and mortality.

Adult↗
PubMed1995

MR staging of acute dural sinus thrombosis: correlation with venous pressure measurements and implications for treatment and prognosis.

PURPOSE: To correlate parenchymal brain changes, venous sinus pressure measurements, and outcome in 29 patients with acute dural sinus thrombosis. METHODS: A retrospective review of 29 patients with angiographically proved acute dural sinus thrombosis was made from January 1989 to December 1993. MR examinations were performed on either a 0.5- or 1.5-T superconductive scanner in multiple planes. Direct dural sinus venography, cerebral angiography, and MR venography were performed. Venous sinus pressure measurements were obtained in 11 of 29 patients. RESULTS: We identified five distinct stages of brain parenchymal changes; each stage correlated with increasing intradural sinus pressure. The pressures measured in this study ranged from 20 to 50 mm Hg. Brain parenchymal changes were reversible up to stage III if thrombolytic treatment was performed. Beyond stage III, there were some residual changes, even after thrombolysis. All stage V patients died. CONCLUSION: Acute dural sinus thrombosis leads to distinct stages of parenchymal changes, the severity of which depends on the degree of venous congestion, which, in turn, is closely related to intradural sinus pressure. As intradural sinus pressure increases, progression from mild parenchymal change to severe cerebral edema and/or hematoma may occur if thrombolysis is delayed.

Acute Disease↗
PubMed1997

Dural sinus thrombosis in children with cancer.

Dural sinus thrombosis (DST) has been reported in association with cancer in both adults and children. We describe the seven patients seen with this complication in our centre between 1981 and 1995. Diagnosis was confirmed by either cerebral CT scanning, MRI or angiography. Median age was 13 years (range 8-15). Six patients were boys. Six children were being treated for non-Hodgkin lymphoma and one for neuroblastoma. Presenting symptoms were seizures and transient neurologic deficit, often preceded by headaches. The probable cause of DST was found in two cases. Tumour localisation in the central nervous system (CNS) probably caused DST in one patient who was treated for ki 1 lymphoma. Dehydration in combination with a poor general condition seemed to be the cause of DST in the patient with neuroblastoma. In five children with stage III or IV non-Hodgkin lymphoma (three lymphoblastic lymphoma; two Burkitt's lymphoma), etiology remained unknown. In these children, DST occurred early in the course of therapy. The median interval between start of chemotherapy and onset of symptoms was 19 days (range 8-40). No child had received L-asparaginase. Prognosis was favourable, with symptoms completely disappearing without therapy within 1 to 5 days. The incidence of DST in patients with advanced stage non-Hodgkin lymphoma during induction and consolidation was calculated to be below 3%. We conclude that DST is rarely diagnosed in children with cancer. Occurrence during the initial phase of therapy for non-Hodgkin lymphoma is associated with a benign prognosis.

Adolescent↗