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At least 19 recordsLinked to original sources
PubMed2004

Cavernous sinus thrombosis complicating sinusitis.

BACKGROUND: Septic cavernous sinus thrombosis is a rare complication of paranasal sinusitis. OBJECTIVE: To familiarize the clinician with the pathogenesis, diagnosis, and appropriate management of septic cavernous sinus thrombosis. DESIGN: Case report and literature review. SETTING: Pediatric intensive care unit in a university hospital. PATIENT: We present a 12-yr-old female with a 1 wk history of an upper respiratory tract infection with worsening dyspnea, cough, and swelling of the left eye progressing to adult respiratory distress syndrome. Secondary to the need for significant mechanical ventilatory support, venovenous extracorporeal membrane oxygenation was initiated. Computed tomography scan of the head and neck with contrast revealed bilateral cavernous sinus thrombosis. After broad-spectrum intravenous antibiotics and aggressive supportive care in conjunction with surgical intervention (maxillary sinus lavage and right orbital exploration) and anticoagulation therapy, the patient recovered. Blood cultures were positive for Viridans streptococcus. At discharge 3 wks later, the patient had improved, but had right-eye blindness. CONCLUSIONS: The diagnosis of septic cavernous sinus thrombosis requires a high index of suspicion and confirmation by imaging; early diagnosis and surgical drainage of the underlying primary source of infection in conjunction with long-term intravenous antibiotic therapy are critical for an optimal clinical outcome.

Anti-Bacterial Agents↗
PubMedDate not supplied

MRI in neonatal dural sinus thrombosis.

Dural sinus thrombosis in the newborn period is a rare but underrecognized condition which may cause seizures, macrocephaly, lethargy, and respiratory depression. A 10-day-old term infant with no pre- or perinatal risk factors for thrombosis presented with seizures and was found to have dural sinus thrombosis on computed tomography and magnetic resonance imaging (MRI). One week later, MRI revealed partial resolution and 3 weeks later disclosed a complete resolution of the thrombosis. Clinicians should consider the diagnosis of neonatal dural sinus thrombosis in infants presenting with seizures and/or increased intracranial pressure even in the absence of risk factors or when the cranial computed tomography is normal. MRI is the most sensitive diagnostic tool to establish the diagnosis and permit a noninvasive follow-up, contributing to our understanding of the natural history, associated pathology, and prognosis of this condition.

Cranial Sinuses↗
PubMedDate not supplied

Neonatal dural sinus thrombosis.

Dural sinus thrombosis in the newborn period has been infrequently documented and its clinical presentation remains obscure. Seventeen patients, all of whom were born at term with dural sinus thrombosis diagnosed in the neonatal period, were retrospectively identified and reviewed. Diagnosis was determined by unenhanced computed tomography which demonstrated a dense sagittal sinus with concomitant small ventricles. Two patients had ancillary studies (i.e., cerebral angiography and nuclear flow scan) which confirmed the diagnosis. Only 4 patients had evidence of perinatal asphyxia. Three patients were identified as having associated conditions known to predispose them to dural sinus thrombosis. None of the patients tested had an identifiable hypercoagulable state. Neonatal seizures were the initial presentation in 15 patients. Seizure onset predominantly occurred during the first week of life. Subsequent examinations were available in all 17 patients and ranged up to 6 years. Only 3 patients had seizures beyond the neonatal period. In 11 of 12 infants with no history of perinatal asphyxia, neurodevelopmental outcomes were normal. Two of 4 infants with perinatal asphyxia had neurologic sequelae. Dural sinus thrombosis represents an important and under-recognized cause of neonatal seizures in term infants. In the absence of perinatal asphyxia, normal neuro-developmental outcome is likely and the risk of seizure recurrence is low.

Cerebral Veins↗
PubMed1988

Experimental study of acute coronary sinus thrombosis--clinical references to coronary sinus thrombosis and coronary venography.

The study was carried out to ascertain the effects caused by thrombosis in the coronary venous system. The coronary sinus (CS) of 21 adult mongrel dogs was abruptly obstructed to produce acute CS thrombosis. These dogs were then tested for serial changes of ECG, coronary arterial blood flow (CBF), left ventricular pressure (LVP), serum enzymes originating from the injured myocardium and histological changes of myocardium. Furthermore, the clinical application of a new coronary venography procedure was investigated. The results obtained in these experiments were as follows; (1) When the CS thrombosis was produced by the abrupt obstruction of the sinus, ECG patterns and serum enzymes originating from the myocardium showed changes similar to those of acute myocardial infarction. (2) The histological examinations showed that the changes in myocardial infarction were characteristically similar to those of hemorrhagic infarction. (3) Despite the complete obstruction of the coronary-venous system by thrombosis, the development of thrombosis or obstruction was not observed on the coronary-arterial side. This phenomenon is probably due to the recirculation of blood flow through the Thebesian vessels. (4) The experiment confirmed that the clear coronary venograms were easily obtained, without any risk, by the fixation of a balloon-tipped catheter inside the CS.

Animals↗
PubMed1998

Bilateral renal vein thrombosis and venous sinus thrombosis in a neonate with factor V mutation (FV Leiden).

Bilateral renal vein thrombosis and venous sinus thrombosis were diagnosed within 3 weeks of birth in a full-term neonate. Heterozygosity for a factor V mutation leading to resistance against the anticoagulatory properties of activated protein C was found. Heparin therapy led to resolution of the thrombotic manifestations. With long-term oral anticoagulation, no relapse or other thrombotic event occurred during infancy.

Anticoagulants↗
PubMed1998

[Lateral sinus thrombosis].

Lateral sinus thrombosis has become a rare complication of the ear in the developed world with the widespread use of antibiotics. The classic clinical picture is often modified by previous antibiotic treatment, which difficult diagnosis and treatment. The authors present the case of a seven year old female who, after an acute left otitis media, treated and later complicated with mastoiditis, presented headaches, neck pain, papilledema and binocular diplopy. Etiologic investigation lead to the diagnosis of left lateral sinus thrombosis. Anticoagulation was started with heparin followed by dicumarinics. This treatment was maintained during eight months. At the moment, the child has no symptoms, with no papilledema or repercussions on visual acuity. The diagnosis of lateral sinus thrombosis and the need for a selection of complementary studies is discussed. A protocol treatment, based on data from a review of the literature, is suggested.

Anti-Bacterial Agents↗
PubMed2002

Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature.

This article reviews the contemporary literature for septic cavernous sinus thrombosis (CST) with a focus on anticoagulation. Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Established treatments include high dose broad-spectrum parenteral antibiotics, and selective surgery for concurrent suppurations. The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the haemorrhagic sequelae of CST radiologically.

Anti-Bacterial Agents↗
PubMed1999

Power Doppler ultrasound imaging in neonatal cerebral venous sinus thrombosis.

Neonatal sinus thrombosis is a rare occurrence in sick neonates. Because of its nonspecific manifestations, the incidence is underestimated. This disease may not be demonstrated by conventional color Doppler and is diagnosed by computed tomography or magnetic resonance imaging. The authors report a neonate with neonatal sinus thrombosis diagnosed by power Doppler and suggest that the technique may be used as a less expensive and more available screening and follow-up method in high-risk neonates.

Female↗
PubMed1996

Sudden cardiac death due to primary coronary sinus thrombosis.

Coronary sinus thrombosis has been reported only as a complication of cardiac transplantation and right heart catheterization in noninfected patients. We report a case of acute coronary sinus thrombosis occurring in the absence of these procedures and resulting in sudden cardiac death.

Aged↗
PubMed1981

[A case report of superior sagittal sinus thrombosis--evaluation of computed tomographic findings in diagnosis and comprehension of this sinus thrombosis (author's transl)].

A case of superior sagittal sinus thrombosis was reported. A 23-year-old male was admitted to our clinic on August 16, 1978, because of generalized convulsive seizures. he had complained of severe headache and high fever for about 7 days before admission, and on admission he was in slightly drowsy state. At that time, bilateral choked discs and bilateral abducens pareses were found without any other neurological deficit. CT scan on his 1st hospital day revealed only slight compression of the ventricular system without any midline shift. On the 2nd hospital day, he developed sudden left hemiparesis, but his level of consciousness did not deteriorate as that of the previous day, demonstrating clear CSF by lumbar puncture. Right CAG on August 21 revealed delayed circulation, poor-filling of the cortical veins, and narrow superior sagittal sinus showing zigzag shaped margin. CT scan on August 22 showed multiple irregular high dense foci mainly in both parietal lobes and the shift to the left of the ventricular system. Besides, on enhanced CT scan, the so-called "empty triangle" sign was revealed with gyral enhancement. Although an increase of the shift of the ventricular system was demonstrated by the follow-up CT scans, he gradually improved and external decompression was necessitated no longer. He was discharged with slight weakness of the left upper limb after superior sagittal sinus showing good-filling on right CAG performed on September 27 and had been identified. As a result, it was confirmed that in case sinus thrombosis is doubted, follow-up study by CT scan would be significant for the choice of treatments as well as for its diagnosis at its each stage.

Adult↗
PubMed1998

Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in [correction of who are] carriers of hereditary prothrombotic conditions. The Cerebral Venous Sinus Thrombosis Study Group.

OBJECTIVE: To investigate whether users of oral contraceptives and in [corrected] carriers of a hereditary prothrombotic condition (factor V Leiden mutation, protein C, S, or antithrombin deficiency) have an increased risk of cerebral sinus thrombosis. DESIGN: Comparison of a prospective series of cases of cerebral sinus thrombosis with population data. SETTING: Neurological teaching hospitals from different regions in the Netherlands (cases) and a representative sample of the non-institutionalised Dutch population (controls). SUBJECTS: 40 women aged 18-54 years with cerebral sinus thrombosis (cases) and 2248 women aged 18-49 years (controls). MAIN OUTCOME MEASURE: Current use of oral contraceptives at the time of the thrombosis (cases) or at the time of the questionnaire (controls). Prevalences of a hereditary prothrombotic condition in patients and in the population with odds ratios. RESULTS: 34 of 40 (85%) women with cerebral sinus thrombosis used oral contraceptives, versus 1007 of 2248 (45%) of the control women; the age adjusted odds ratio was 13 (95% confidence interval 5 to 37). Seven of 36 patients (19%) had a prothrombotic deficiency, versus 7% expected in the population; this corresponds to a threefold to fourfold increase in risk. In women who used oral contraceptives and also carried a prothrombotic defect, the odds ratio for cerebral sinus thrombosis was about 30 relative to women who had neither risk factor. CONCLUSION: The use of oral contraceptives and being a carrier of a hereditary prothrombotic condition increase the risk of and interact in a multiplicative way in the development of cerebral sinus thrombosis.

Adolescent↗
PubMed2002

Polycythemia mimicking venous sinus thrombosis.

Venous sinus thrombosis is a relatively uncommon disorder that frequently is associated with confusing clinical findings and delayed diagnosis. Patients are often screened with unenhanced CT, and CT findings may be subtle and may include hyperattenuation of cerebral veins or venous sinuses secondary to intracranial thrombosis. This hyperattenuation may be mimicked by polycythemia, as shown in this case.

Adult↗
PubMed2001

Diabetes mellitus with left transverse sinus thrombosis and right transverse sinus aplasia.

A 67-year-old woman with diabetes mellitus was hospitalized due to a throbbing headache. She appeared neurologically normal, except for meningeal irritation. The cerebrospinal fluid pressure was high. There was increased fluid protein without an increased cell count. Brain CT scan showed no abnormality, however, brain magnetic resonance angiography (MRA) showed complete right transverse sinus stasis and partial left transverse sinus stasis, indicating bilateral transverse sinus thrombosis. At this time thrombin anti-thrombin III complex (TAT) and prothrombin fragment F1+2 (PTF1+2) indicating hypercoagulation had increased. Urokinase, followed by aspirin and ticlopidine hydrochloride were administered. After diet therapy and transient insulin administration, her blood glucose levels improved. By the 22nd day, the headache had disappeared. Subsequently, brain MRA showed left transverse sinus blood flow recovery and complete right transverse sinus stasis, while carotid angiography showed recovered left transverse sinus but right transverse sinus defect. TAT and PTF1+2 levels improved concomitantly with better blood glucose control. We diagnosed this case as left transverse sinus thrombosis because of the hypercoagulable state resulting from diabetes mellitus accompanied by right transverse sinus aplasia.

Aged↗
PubMed1983

[Case of aseptic primary cavernous sinus thrombosis].

Cavernous sinus thrombosis (CST) is classified into aseptic and septic types on the basis of its pathognosis. Aspetic CST includes the primary and secondary types, in which the former is an unknown etiology. We have recently experienced a rare case of aseptic primary CST which showed initially the intraorbital congestive symptoms. This 64 years male admitted to our clinic with the complaints of non-pulsatile exophthalmosis and conjunctival congestion of left eye. On admission, he showed mild external ophthalmoplegia and clinical evidence of intraorbital congestion (choked disc, retinal vein thrombosis, retinal hemorrhage) on the left side. The blood examination, including the thyroid studies, revealed no abnormal findings except for mild anemia and increased ESR. In carotid angiography, there was occlusion of Sylvian vein and cavernous sinus in the affected side. Orbital venography and retrograde jugular venography demonstrated the occlusion of superior ophthalmic vein, cavernous sinus and inferior petreous sinus in left side. CT scan revealed parasellar enhanced area in the normal pattern. Enhanced orbital CT scan revealed the hypertrophy of left external occular muscles and optic nerve with a tomogram of the dilatated superior ophthalmic vein. Aseptic primary CST was diagnosed on the basis of clinical course, cavernous sinography and CT findings.

Betamethasone↗
PubMed2001

Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. For The Cerebral Venous Sinus Thrombosis Study Group.

The prognosis of cerebral venous sinus thrombosis (CVST) is variable, and outcome may range from complete recovery to death. Prognostic factors to predict outcome in the acute phase of CVST have not been analysed in a prospective study. Prognostic factors in patients enrolled in a clinical treatment trial were prospectively investigated. Poor outcome after 12 weeks, defined as death or dependency (Oxford handicap score > or =3), was used as the principle outcome measure. Univariate relations between possible prognostic factors and outcome at 12 weeks were analyzed with chi(2) tests. Treatment and all factors associated with prognosis (p< or = 0.25) were forced into a logistic regression model with a forward selection procedure. Fifty nine patients (50 women, nine men) were studied, with a mean age of 37 years (range 18 to 80 years). After 12 weeks 10 patients (17%) had a poor outcome. The univariate identified factors related to poor outcome were papilloedema, altered consciousness, coma, age older than 33 years, diagnostic delay < or =10 days, intracerebral haemorrhage, and involvement of the straight sinus. Isolated intracranial hypertension and a delta sign on CT were associated with good outcome. In the multivariate analysis coma and cerebral haemorrhage were significantly associated with a poor outcome, with odds ratios of 8.2 (95% confidence interval (95% CI) 1. 3-50.1) and 20.7 (95% CI 1.6-264.3) respectively. Involvement of the straight sinus was also weakly, but not significantly, associated with poor outcome. In conclusion, coma and intracerebral haemorrhage are independent predictors for poor outcome of CVST.

Adolescent↗
PubMed1991

[Neonatal dural sinus thrombosis].

Neonatal dural sinus thrombosis is a relatively unknown disease. We recently diagnosed two newborn patients with dural sinus thrombosis. Both patients had associated conditions known to predispose to dural sinus thrombosis. One patient had severe perinatal asphyxia, and the other patient had a deficiency of antithrombin III. Both patients had severe neonatal seizures. The literature on some aspects of this entity is discussed. It is concluded that dural sinus thrombosis may represent an important and underrecognized cause of neonatal seizures.

Antithrombin III Deficiency↗