A 29-yr-old multiparous woman presented with a postural headache four weeks after a normal pregnancy and vigorous delivery. [ncbi.nlm.nih.gov]

• Fever

  A two and half year-old-male child, known case of steroid responsive nephrotic syndrome presented with fever and vomiting of acute onset. [ncbi.nlm.nih.gov]

  She denies recent trauma, fevers, neck stiffness, substance abuse, IVDA, ill contacts, and foreign travel. Her medication list is notable only for an estrogen containing oral contraceptive. [emdocs.net]

  There was no associated fever, sinus congestion, neck stiffness, or visual or focal neurological symptoms. There was no family history of migraine or other headache disorder. The patient had begun his third year of law school 3 weeks earlier. [accessemergencymedicine.mhmedical.com]

  It was not accompanied by fever, vomiting, nor seizure. A week later, he started having mild blurring of vision and intermittent binocular diplopia. [asean-endocrinejournal.org]

• Goiter

  Both patients presented with hemiplegia, seizures, and a large goiter. The development of superior sagittal sinus thrombosis is multifactorial. [ncbi.nlm.nih.gov]

  These phenomena are known to occur in thyrotoxicosis. 9 12 Both described patients presented with large goiters. We also hypothesize that a large thyrotoxic goiter may cause stasis of the venous blood flow from the central nerve system. [stroke.ahajournals.org]

• Hunting

  Hunt MG, Lee AG, Kardon RH, Lesley WS, Chaloupka JC : Improvement in papilledema and visual loss after endovascular stent placement in dural sinus thrombosis. Neuroophthalmology 26 : 85-92, 2001 10. [jkns.or.kr]

• Respiratory Distress

  A 30-year-old man presented with altered mental status after a motorcycle collision, and subsequently developed respiratory distress. [ncbi.nlm.nih.gov]

• Recurrent Vomiting

  A 2-year-old boy with new-onset nephrotic syndrome developed recurrent vomiting, apathy and papilloedema. Superior sagittal sinus thrombosis was diagnosed on cranial CT and MRI. [ncbi.nlm.nih.gov]

• Arm Weakness

  Neurologic examination showed left arm weakness and sensory loss, blurring of the left optic disc, and bilateral Babinski signs. [ncbi.nlm.nih.gov]

• Seizure

  This case also extends the clinical spectrum of cerebral sinus thrombosis to include recurrent transient ischemic attacks alternating with seizures. [ncbi.nlm.nih.gov]

• Altered Mental Status

  A 30-year-old man presented with altered mental status after a motorcycle collision, and subsequently developed respiratory distress. [ncbi.nlm.nih.gov]

  mental status, possibly transient global amnesia, visual disturbances, alexia. [ispub.com]

  mental status or GCS Male Age >37 years CVT affects the deep venous system References and Links LITFL CCC — Thrombophilia screen Journal articles Alvis-Miranda HR, Milena Castellar-Leones S, Alcala-Cerra G, Rafael Moscote-Salazar L. [lifeinthefastlane.com]

  mental status, focal neurologic deficits, coma, and/or death because of venous infarction of the bilateral thalami and basal ganglia.[ 6 ] Typical MRI findings are high signal intensity and swelling of the bilateral thalami, internal capsules, and basal [surgicalneurologyint.com]

  Studies indicate that there are predictors of increased mortality, namely: depressed consciousness, altered mental status, thrombosis of the deep venous system, right hemisphere hemorrhage, or posterior fossa lesions [ 3 - 5, 7 ]. [omicsonline.org]

• Dysphasia

  A 42-year-old male presented with right-sided weakness, dysphasia and seizures while climbing the French Alps at an approximate altitude of 3,000 m. Imaging studies were consistent with superior sagittal sinus thrombosis with hemorrhage. [ncbi.nlm.nih.gov]

  […] description of 110 patients with cerebral venous thrombosis, Ameri and Bousser (3) found a wide spectrum of physical signs and symptoms, including headache, papilledema, motor or sensory deficits, drowsiness, mental status changes, seizures, confusion, coma, dysphasia [ajnr.org]

• Excruciating Headache

  She also complained of excruciating headache. A FDG PET scan was done an hour after intravenous administration of 444 MBq (12 mCi) of F-18 FDG, on a dedicated PET scanner. [ncbi.nlm.nih.gov]

• Amnesia

  […] started on oral contraceptives, a young patient with subacute non resolving headache that develops seizures or a focal neurological deficit, an ICH in an unusual localization, a thunderclap headache, altered mental status, possibly transient global amnesia [ispub.com]

Further workup for an underlying cause of sinus thrombosis disclosed symptoms and signs fulfilling the diagnostic criteria for Behcet's disease. [ncbi.nlm.nih.gov]

During this inpatient visit, a thrombophilia workup revealed a homozygous 4G/4G genotype. [mdedge.com]

No conditions that could result in CVT were found despite an extensive etiologic workup. He was treated with heparin followed by oral anticoagulant and he significantly improved. [annalsofian.org]

A hypercoagulability workup performed which included Factor V, Prothrombin Gene mutation, homocysteine; Protein C&S, ATIII, ACE, Fibrinogen, Anti-beta 2 glycoprotein, Anti-Cardiolipin, and Lupus screen were all negative. [omicsonline.org]

(See Workup.) Left lateral sinus thrombosis demonstrated on magnetic resonance venography (MRV). This 42-year-old woman presented with sudden onset of headache. Physical examination revealed no neurologic abnormalities. [emedicine.medscape.com]

Sinus thrombosis resulting after endovascular or surgical treatment of dural arteriovenous fistulous connections has been reported in literature and is considered a possible complication of treatment. [ncbi.nlm.nih.gov]

Case Report: A 32-year-old man with lymphoblastic lymphoma received treatment with daunorubicin, vincristine, and prednisone. He developed postural headache and severe nausea and vomiting after a diagnostic lumbar puncture. [scholars.northwestern.edu]

Dural sinus thrombosis is a relatively rare syndrome, often with a very poor prognosis. Systemic anticoagulant therapy has produced poor results; therefore rapid recanalization of the affected vessels is essential. [ncbi.nlm.nih.gov]

Links: aetiology pathogenesis clinical features investigations treatment prognosis [gpnotebook.co.uk]

The prognosis of CVT varies, from complete recovery, to residual neurological deficits, to death. Revised 11/29/06. Copyrighted 2006. David C Preston [casemed.case.edu]

Prior to the advent and widespread use of antibiotics in developed nations, CVT was largely due to infectious etiologies such as mastoiditis, orbital cellulitis, and facial cellulitis[2]. Risk Factors Table 1. [eyewiki.aao.org]

Neonatal polycythemia and dehydration were thought to be etiological factors. CT scan revealed massive brain edema with slitlike ventricles. Increased density of the torcular Herophili and straight sinus was demonstrated in two cases. [ci.nii.ac.jp]

The etiology of CVT is diverse but most often includes the following: ● Genetic hypercoagulable states (e.g., protein S and C deficiencies, antithrombin III deficiency, Leiden factor V mutation) ● Oral contraceptives ● Pregnancy / puerperium ● Collagen [casemed.case.edu]

Orbital cellulitis is the most common precipitating etiology of septic CSVT – look for headache, fever, and opthalmoplegia. 3 References: Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005; 352:1791-1798. [emdocs.net]

[…] the risk of death or dependency. 11 The duration of anticoagulant therapy in CSVT depends on the etiology as well. [asean-endocrinejournal.org]

Answer: Cerebral Sinus Venous Thrombosis (CSVT) 1-8 Epidemiology: 1,2 In the U.S., CSVT accounts for < 1% of ischemic strokes and typically affects young people. Estimated incidence: 3-4 cases per million adults and 7 cases per million children. [emdocs.net]

MRV of the Cerebral Venous System (Saposnik 2011) Epidemiology More common in young (median age = 38) women (60-75% of cases) Rare disease: 0.5-1% of all strokes ( Saposnik 2011 ) Mortality: 10-30% ( Williams 2004 ) Risk Factors Virchow’s Triad: stasis [coreem.net]

Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme – The International Classification of Diseases is the international standard diagnostic tool for epidemiology, health management and clinical purposes. [wikivisually.com]

The rate of recurrence was low (2.8%). [15] In children with CVST the risk of death is high. [16] Poor outcome is more likely if a child with CVST develops seizures or has evidence of venous infarction on imaging. [17] Epidemiology [ edit ] Cerebral venous [en.wikipedia.org]

Epidemiology: minimal estimates of incidence range from 0.4-0.7/100,000/year in children, up to 2.6/100,000/year in neonates, and is greater in boys than in girls, with a ratio of 60:40. [clinicaladvisor.com]

The standard evaluation of patients with intracranial hypertension frequently does not reveal a discrete pathophysiologic process, leading in these cases to classification of the syndrome as "benign." [ncbi.nlm.nih.gov]

[…] straight sinus, and then to the internal jugular vein (IJV) Superficial venous system has numerous anastomses and predominantly drain the SSS and the LS Deep white matter and basal ganglia are drained by the deep venous system toward the vein of Galen Pathophysiology [lifeinthefastlane.com]

[…] polyangiitis (formerly known as Wegener’s granulomatosis) Churg-Strauss syndrome Thromboangiitis obliterans Inflammatory bowel disease Sarcoidosis Other disorders Thyroid disease (thyroiditis, hyperthyroidism, hypothyroidism) General Pathology Add text here Pathophysiology [eyewiki.aao.org]

J Infect, 2004. 48(1): p. 86-90. 7.Filippidis, A., et al., Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment. Neurosurg Focus, 2009. 27(5): p. E3. 8.Karam, C. and S. [degruyter.com]

Early and vigilant recognition of superior sagittal sinus thrombosis and prompt anticoagulation with LMWH may prevent further neurological damage. [ncbi.nlm.nih.gov]

Some treatment may focus on preventing the blood clot from getting bigger. [chop.edu]

This prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage. This chain of events is part of a stroke that can occur in adults and children. [hopkinsmedicine.org]

CVT is an important diagnosis to recognize, as anticoagulation is indicated to prevent further clot formation. The prognosis of CVT varies, from complete recovery, to residual neurological deficits, to death. Revised 11/29/06. Copyrighted 2006. [casemed.case.edu]