Edit concept Question Editor Create issue ticket

Sagittal Sinus Thrombosis

Thrombosis Superior Longitudinal Sinus


Presentation

  • A 29-yr-old multiparous woman presented with a postural headache four weeks after a normal pregnancy and vigorous delivery.[ncbi.nlm.nih.gov]
  • Although 4 patients presented with subarachnoid haemorrhage, these direct signs were present in 3 patients.[ncbi.nlm.nih.gov]
  • We report the first case of a patient who presented with acute traumatic SSST and concomitant PE. A 30-year-old man presented with altered mental status after a motorcycle collision, and subsequently developed respiratory distress.[ncbi.nlm.nih.gov]
  • Subclinical infection of the sinuses can result in delayed diagnosis and unusual presenting complications.[ncbi.nlm.nih.gov]
  • In the present case, a patient in whom thrombosis coexisted with intracranial hemorrhage was successfully treated using thrombolytic therapy.[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]
  • We report on a 66-year-old man who presented with a fever of undetermined origin, a splenomegaly, and an elevated lactate dehydrogenase level.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • 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]
Goiter
  • Both patients presented with hemiplegia, seizures, and a large goiter. The development of superior sagittal sinus thrombosis is multifactorial.[ncbi.nlm.nih.gov]
  • Patients with thyrotoxicosis and a diffuse goiter may be predisposed to the development of SSS thrombosis, as a result of hypercoagulation and stasis of local venous blood flow.[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]
Down Syndrome
  • Moyamoya syndrome and cerebral venous thrombosis should not be overlooked as a cause of acute neurological deterioration in a child with Down's syndrome.[ncbi.nlm.nih.gov]
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]
  • An 8(1/2)-year-old-female child with steroid-resistant nephrotic syndrome developed sagittal sinus thrombosis while on pulse therapy with corticosteroids, presenting with recurrent vomiting, headache, and impaired consciousness.[ncbi.nlm.nih.gov]
Pulsatile Tinnitus
  • Case 2 is a 50-year-old male with a past history of SSS thrombosis with protein S deficiency who developed pulsatile tinnitus and generalized seizure.[ncbi.nlm.nih.gov]
High Forehead
  • He also had macrocephaly; a high forehead; capillary hemangioma on the forehead, upper lip, and philtrum; generalized loose skin; postaxial polydactyly of both hands and feet, with neuroimaging findings of polymicrogyria and thrombosis in sagittal sinus[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]
  • X-ray and CT right shoulder showed shoulder dislocation secondary to trauma associated with seizure prior to hospital admission.[ncbi.nlm.nih.gov]
  • Case 2 is a 50-year-old male with a past history of SSS thrombosis with protein S deficiency who developed pulsatile tinnitus and generalized seizure.[ncbi.nlm.nih.gov]
  • A14-year-old boy presented with epileptic seizures and thrombosis of the superior sagittal sinus and frontal hemorrhagic venous infarction after ingestion of 50 mg of dimenhydrinate, an antiemetic drug.[ncbi.nlm.nih.gov]
  • Both patients presented with hemiplegia, seizures, and a large goiter. The development of superior sagittal sinus thrombosis is multifactorial.[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 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]
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]

Workup

  • 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]
  • 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]

Treatment

  • 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]
  • Early diagnosis combined with surgical and medical treatment resulted in cure of the disease.[ncbi.nlm.nih.gov]
  • Pathogenesis and different modalities of treatment are discussed.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]
  • Dose-adjusted heparinization is recommended as the first-line treatment of choice, while intravascular thrombolysis or operative thrombectomy is an aggressive but effective treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis is variable and spontaneous resolution has been reported. Successful treatment options of spontaneous cases include systemic anticoagulation and thrombolytic therapy along with supportive measures.[ncbi.nlm.nih.gov]
  • 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]

Etiology

  • The literature was reviewed and etiology and management were discussed. 1982 The American College of Obstetricians and Gynecologists Related Articles[journals.lww.com]
  • 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 risk of death or dependency. 11 The duration of anticoagulant therapy in CSVT depends on the etiology as well.[asean-endocrinejournal.org]
  • Risk Factors and Etiology Inherited and Acquired hypercoagulable states Cerebral venous sinus thrombosis (CVST) and cerebrovascular accident (CVA) often result from a hypercoagulable state (HCS), and both acquired and inherited factors place patients[mdedge.com]
  • 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]

Epidemiology

  • 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]
  • 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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • The pathophysiology of cerebral venous thrombosis with associated venous stroke appears to differ from that of arterial strokes. The purpose of this study was to describe DWI findings in venous strokes.[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]
  • ., 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. Koussa, Cerebral dural sinus thrombosis following cisplatin chemotherapy.[degruyter.com]

Prevention

  • Early and vigilant recognition of superior sagittal sinus thrombosis and prompt anticoagulation with LMWH may prevent further neurological damage.[ncbi.nlm.nih.gov]
  • It has been clearly demonstrated that the anticoagulant functions of the protein C system are important in the prevention of thromboembolic disease.[ncbi.nlm.nih.gov]
  • An inhibitor to the pathway of fibrinolysis, PAI-1 is a major factor preventing the excessive presence and magnitude of blood clots. 3 Pregnancy and the Puerperium Cerebral vascular sinus thrombosis is most commonly seen in young to middle-aged women.[mdedge.com]
  • Emergent exploration was performed to prevent complications such as infection, sinus thrombosis and delayed development of intracranial hypertension.[austinpublishinggroup.com]
  • Some treatment may focus on preventing the blood clot from getting bigger.[chop.edu]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!