Case report bilateral cavernous sinus thrombosis and. Dural sinus thrombosis dst is a disease entity in which early diagnosis can make an important difference with regards to patient outcome. This article focuses on the specific features related to the superior sagittal sinus thrombosis, please refer to t. Get a printable copy pdf file of the complete article 1. Ct venography and mr venography detected partial superior sagittal sinus thrombosis, which leads to the empty delta sign the intraluminal thrombus prevents central filling of the sinus. Suppurative thrombophlebitis of the superior sagittal sinus, however, is uncommon and occurs significantly less frequently than does septic thrombosis of the cavernous or transverse sinuses. Fatal septic thrombosis of the superior sagittal sinus after. Mar 08, 2012 the clinical manifestations of cerebral venous thrombosis vary, depending on the extent, location, and acuity of the venous thrombotic process as well as the adequacy of venous collateral circulation. In comparison, deep venous thrombosis dvt of the lower extremity is approximately 250 times as common. Cerebral venous sinus thrombosis cvst is a rare special cerebrovascular disease, accounting for 1% of all strokes, but the mortality rate is as high as 10%. Mar 21, 2019 lateral sinus thrombosis is a potentially fatal condition in which early diagnosis may be difficult because of previous antibiotic therapy.
Additionally, she had difficulty moving her right leg which made it hard to walk. Treatment of the superior sagittal sinus and transverse. Cerebral vein and cerebral venous sinus thrombosis is an uncommon type of clot. Upmc neurosurgeons may recommend a combination of surgical and nonsurgical approaches to treating sinus thrombosis. A 34yearold man presented with rightsided weakness.
Multisinus thrombosis was most common followed by superior sagittal sinus thrombosis. Extensive sinus thrombosis involving most of the superior sagittal sinus except the posterior portion. We report a case of a 42 year old nepali man diagnosed with cerebral venous sinus thrombosis after presenting with a week long history of continuous headache. Manometry demonstrated elevated venous pressures and these normalized after thrombectomy. Superior sagittal sinus thrombosis multiple veins empty into the sagittal sinus, making it the largest venous channel in the brain. The prognosis can vary from complete recovery to rapid death. Heparin treatment in sinus venous thrombosis pdf free download.
Cerebral venous sinus thrombosis presenting as idiopathic. Increased risk of venous thrombosis in ibd has been well described, usually within the deep veins of the legs or the pulmonary circulation 1. Symptoms are similar to the more common conventional stroke, but can be less severe and therefore more difficult to diagnose. Cerebral venous sinus thrombosis complicated by subdural. The superior sagittal sinus also known as the superior longitudinal sinus, within the human head, is an unpaired area along the attached margin of the falx cerebri. Common etiologies include hypercoagulable diseases, low flow states. Treatment and management of venous sinus thrombosis. Generalized neurologic symptoms eg,headache, experienced by 75%95% of patients and focal neurologic deficits, including seizure, may result.
Computed tomographic angiography cta revealed a contrast filling defect in the superior sagittal sinus and right transverse sinus, indicating cvt fig. Csvt is a multifactorial condition with genderrelated specific causes, with a. An unusual presentation of tubercular adenitis lin es trials, 2017 doi. Cerebral vein and sinus thrombosis cvst is a rare event in comparison with arterial stroke, accounting for less than 1% of all strokes. Its occurrence simultaneously with pulmonary embolism pe is much rarer. In comparison, deep venous thrombosis dvt of the lower extremity is. Partially recanalized chronic dural sinus thrombosis. Treatment of the superior sagittal sinus and transverse sinus thrombosis associated with intracranial hemorrhage with the mechanical thrombectomy and thrombolytics. Cerebral sinus venous thrombosis in the superior sagitt openi. Superior sagittal sinus thrombosis presenting as a.
We attempted to do mechanical thrombectomy by placed solitair ab stent in the sss, respectively, passed left and right sigmoid sinus transverse sinus route. Thrombosis in the sagittal sinus often leads to impaired venous drainage and, therefore, parenchymal change in the parasagittal region. Overview 6% of all intracranial complications of csom in csom direcrt spread through bone erosion and thrombophlebitic spread through emissary veins in asom spread is mainly through emissary veins 3. Cerebral sinus venous thrombosis csvt is a rare phenomenon that can be seen with some frequency in young patients.
Magnetic resonance imaging of thrombosed dural sinuses. Superior sagittal sinus thrombosis is more frequently associated with hypercoagulable states including malignancy, pregnancy, and ulcerative colitis fig. Get a printable copy pdf file of the complete article 952k. The superior sagittal sinus, draining the upper part of the cerebral hemispheres, is affected by thrombosis, usually as an extension of cortical vein thrombosis. Radiologic diagnosis of cerebral venous thrombosis. Presentation and progression of papilledema in venous. Can an mri without contrast rule out a superior sagittal sinus thrombosis. Sagittal sinus thrombosis after closed head injury. There was no change in the hemoglobin level or platelet count. The sagittal sinus is a major draining vein of the brain that runs along the middle of the head from front to back. An analysis showed that even after the introduction of antibiotics, the preponderance of these cases have been diagnosed at autopsy. Sagittal sinus thrombosis, also called a cerebral venous sinus thrombosis, is a rare and potentially fatal type of stroke resulting from a blood clot that obstructs the flow of venous blood away from the brain through one of the intracranial sinuses.
Superior sagittal sinus thrombosis ssst is associated with a host of predisposing factors, including pregnancy, collagen vascular disease, malignancy, diabetes insipidus, and medications such as oral contraceptive agents, lasparaginase, androgens, and heparin. Inability to correctly diagnose dst can occasionally allow the disease to progress to a critical state manifested by cerebral. Crohns disease and ulcerative colitis are the two main subtypes. The right and left cavernous sinuses are situated on the lateral aspect of the sella turcica. In the antibiotic era, the presentation of lateral sinus thrombosis has changed from pronounced signs and symptoms to vague and nonspecific symptoms. Superior sagittal sinus an overview sciencedirect topics. This article focuses on the specific features related to the superior sagittal sinus thrombosis, please refer to the d ural venous sinus thrombosis article for a general discussion risk factors include pregnancy, dehydration, hypercoaguable states, pancreatitis. Magnetic resonance imaging and venography of the patients head demonstrated thrombosis of the anterior and midsuperior sagittal sinus, multiple venous infarcts, prominent leptomeningeal enhancement, and a left subdural fluid collection. Pdf posttraumatic superior sagittal sinus thrombosis. Embolism, puerperium, pulmonary, sagittal sinus, thrombosis case report introduction superior sagittal sinus thrombosis is a relatively rare and often misdiagnosed condition. Department of medicine, dalhousie university, halifax, ns.
Cerebral venous thrombosis is located in descending order in the following venous structures. Diagnosis and treatment of superior sagittal sinus thrombosis. Cerebral venous sinus thrombosis cvst is cerebral venous sinus thrombosis cvst is a rare and potentially deadly condition. Superior sagittal sinus thrombosis and pulmonary embolism. Sinus vein thrombosis is increasingly recognized as a much more frequent neurological disorder than was anticipated before. The appropriate management of cvst remains to be defined. Most such patients present with symptoms of elevated intracranial pressure that may rapidly escalate to a coma, 45, 46. This is a rare disorder and can be of two typesseptic cavernous thrombosis and aseptic cavernous thrombosis. Following treating a case of superior sagittal sinus thrombosis, we did an extensive search of the literature, eliciting 795 cases of the disorder. The clinical manifestations and extent of brain injury in acute sinus thrombosis. Treatment of the superior sagittal sinus and transverse sinu. Periorbital cellulitis, subgaleal abscess and superior.
Cerebral venous sinus thrombosis cvst is a rare clinicopathological entity with substantial diagnostic and therapeutic dilemmas. We examined the pathophysiology of superior sagittal sinus thrombosis ssst from 19 patients and a rat ssst model. Cvst occurs in all age groups, peaking in incidence among neonates and young adults. Posttraumatic superior sagittal sinus thrombosis article pdf available in goztepe tip dergisi 201. Treatment and management of venous sinus thrombosis sebastian pollandt, md. Pdf on jan 1, 2016, tahir majeed and others published sagittal sinus thrombosis. Apr 29, 2020 sagittal sinus thrombosis, also called a cerebral venous sinus thrombosis, is a rare and potentially fatal type of stroke resulting from a blood clot that obstructs the flow of venous blood away from the brain through one of the intracranial sinuses. Reversibility of severe sagittal sinus thrombosis with open surgical thrombectomy combined with local infusion of tissue plasminogen activator. Lateral sinus thrombosis this type of clot is usually associated with bacterial infections in the mastoid sinus. It can present with the usual features of raised intracranial pressure, such as headache and vomiting in adults and a tense fontanelle in infants. Bulky scalp metastasis and superior sagittal sinus thrombosis from a cervical adenocarcinoma. Cerebral venous sinus thrombosis presents a diagnostic challenge due to its varied presentation patterns.
Cerebral venous thrombosis venous sinus thrombosis cortical vein thrombosis relatively rare cause of stroke pdf on jan 1, 2016, tahir majeed and others published sagittal sinus thrombosis. We report a case of nontraumatic sagittal sinus thrombosis complicated by multiple pulmonary emboli and a fatal saddle embolism, likely originating from the thrombosed sinus. Superior sagittal sinus thrombosis and hiv annals of. Experimental production of superior sagittal sinus.
Cerebral venous sinus thrombosis cvt can occur after neurosurgical instrumentation, particularly after surgeries that are interhemispheric, include sagittal sinus instrumentation, or involve a subtemporal approach. Bilateral cavernous sinus thrombosis and facial palsy as complications. Clinical outcome is typically dependent on the timeliness of diagnosis and definitive treatment. Vein of trolard, which is the largest cortical vein that drains into the superior sagittal sinus. Because of the inherent heterogeneity of the appearance of venous thrombosis, a segment approach was used in which the cerebral venous system was divided into these segments for separate evaluation. Puerperal superior sagittal sinus thrombosis and pulmonary. All sinovenous thrombosis cases were confirmed with mrimr venography. Sinus thrombosis venous sinus thrombosis sagittal sinus. Fii g20210a mutation was present in 2 of 18 tested neonates 11%. Dural sinus thrombosis is a rare, potentially fatal complication of a radical neck dissection. An unusual presentation of tubercular adenitis find, read and cite all the research you need on researchgate. Magnetic resonance venography provides an effective, noninvasive diagnosis.
Superior sagittal sinus thrombosis ssst is the most common type of dural venous sinus thrombosis and is potentially devastating. Eldairi1 departments of ophthalmology,1 neurology2 and neurosurgery,3 duke eye center and duke university medical center, durham, nc purpose conclusions methods results. Antibiotic treatments have made this type of clot uncommon. Symptoms are similar to the more common conventional stroke, but can be less severe and. Pdf superior sagittal sinus thrombosis associated with. Sep 03, 2002 to our knowledge, cerebral venous sinuses thrombosis, a rare disease described as early as 1825, has not been described as an initial presentation of hiv. Dsa revealed extensive thrombosis of the superior sagittal sinus sss fig. Cerebral venous sinus thrombosis is the presence of a blood clot in the dural venous sinuses, which drain blood from the brain. Superior sagittal sinus thrombosis presenting as a continuous.
An experimental method was devised of inducing sss thrombosis in the dog by use of doublelumen balloon catheters. Cect chest abdomen and pelvis was normal however contrast imaging of neck showed multiple enlarged matted. The clinical manifestations of cerebral venous thrombosis vary, depending on the extent, location, and acuity of the venous thrombotic process as well as the adequacy of venous collateral circulation. There is an area of high t2 signal with diffusion restriction dwi sequence not posted in this case demonstrated in the left frontal lobe suggestive of venous infarction. Pdf thrombosis of the sinuses is a distinct cerebrovascular disorder that, unlike arterial stroke, most often affects young adults and children.
Diagnosis and management of cerebral venous thrombosis. We report a case of successful rapid thrombectomy of extensive thrombus within the superior sagittal and transverse sinuses using a rheolytic catheter device. Cerebral venous sinus thrombosis cvst is the presence of a blood clot in the dural venous sinuses, which drain blood from the brain. Sagittal sinus thrombosis due to lasparaginase wani na. High resolution computed tomography of superior sagittal sinus thrombosis and abnormalities. Pmc free article thron a, wessel k, linden d, schroth g, dichgans j. I had an mri without contrast and it w more can an mri without contrast rule out a superior sagittal sinus thrombosis. Superior sagittal sinus thrombosis after radical neck. Sinusvein thrombosis is increasingly recognized as a much more frequent neurological disorder than was anticipated before. The diagnosis is usually by computed tomography or magnetic resonance imaging to demonstrate obstruction of the venous. The goals of therapy are to decrease intracranial pressure and to lyse the thrombus. Time of flight tof is the most commonly used non contrast mrv technique2.
Report of a recurrent cerebral venous thrombosis in a young. Thrombosis of the cerebral venous system, also known as cerebral venous and sinus thrombosis cvt or dural sinus thrombosis, is a rare condition, with an estimated annual incidence of 24 per million. Pdf bulky scalp metastasis and superior sagittal sinus. Management and outcome of cerebral venous thrombosis after head trauma. Blood cultures taken at the time of admission yielded mrsa, and therapy was adjusted to vancomycin. Subsequent magnetic resonance imaging mri scan showed a cerebral sinus venous thrombosis in the superior sagittal sinus fig. Neuroimaging identified ipsilateral transverse sinus thrombosis with retrograde flow into the opposite sinus. Cerebral venous sinus thrombosis presenting with multifocal. Presentation and progression of papilledema in venous sinus thrombosis katy c.
Sagittal sinus thrombosis 1angelnurse five months ago my 17 yo daughter woke up with a headache which after ct scans, mris, mras and an angiogram of the brain she was diagnosed with sagittal sinus thrombosis. We treated 19 cases with ssst who were diagnosed by angiography. Neonatal cerebral sinovenous thrombosis from symptom to. Angiography performed after endovascular treatment demonstrated a normal venous drainage pattern. G08 thrombosis of superior sagittal sinus averbis gmbh. Thrombosis of the internal cerebral veins, vein of galen, or straight sinus has been observed in approximately 16% of patients with cerebral venous thrombosis, 3, 14. Compared with men, women were significantly younger median age 34 years, versus 42 years for men 6. Sep 22, 2014 brain mri revealed thrombosis of the straight sinus extended to the right lateral sinus figure 1b with bithalamic hyperintensities observed in t2 and fluid attenuated inversion recovery sequences figure 2a, and no modification of the aspect of the superior sagittal sinus. Experimental production of superior sagittal sinus thrombosis in the dog 19 prior efforts at experimental production of superior sagittal sinus sss thrombosis generally have been unsuccessful. Cavernous sinus thrombosis cst is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. Superior sagittal sinus, transverse, straight and sigmoid sinuses.
Bilateral or unilateral infarction in the thalami, basal ganglia. Abstract a case of delayed signs of intracranial hypertension following closed head injury with a depressed cranial fracture and superior sagittal sinus thrombosis is reported. Periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis. Pdf thrombosis of the superior sagittal sinus sefedin. Mr venography is a widely used non invasive imaging technique to diagnose cerebral dural venous sinus thrombosis cvst and intracranial venous abnormalities 1. Symptoms may include headache, abnormal vision, any of the symptoms of stroke such as weakness of the face and limbs on one side of the body, and seizures. We report a case of a female patient with active crohns disease, complicated by acute cerebral venous sinus thrombosis cvst. She was managed conservatively with hydroxyurea, hydration, and aspirin. In the international study on cerebral vein and dural sinus thrombosis iscvt, the median age of patients with cvt was 37 years, and only 8 percent of the patients were older than 65. The association between otogenic lateral sinus thrombosis and thrombophilia a longterm followup. Pdf normal variations and artifacts in mr venography. Superior sagittal sinus thrombosis radiology reference. Partial, nonthrombotic, superior sagittal sinus occlusion due to occipital skull tumours.
Cerebral venous sinus thrombosis presenting as idiopathic intracranial hypertension. It allows blood to drain from the lateral aspects of anterior cerebral hemispheres to the confluence of sinuses. Heparin treatment in sinus venous thrombosis sir,professor einhaupl and colleagues report sept 7, p 597 of the use of adjusted dose intravenous heparin in the treatment of cerebral sinus venous thrombosis svt is important but leaves many questions unanswered. Mar 21, 2019 the association between otogenic lateral sinus thrombosis and thrombophilia a longterm followup. Direct thrombolysis for cerebral venous sinus thrombosis. Thrombosis of the dural venous sinuses is a potentially lethal condition that remains a diagnostic dilemma.