Dural sinus

Tsai FY, Wang AM, Matovich VB, Lavin M, Berberian B, Simonson TM, Yuh W. MR staging of acute dural sinus thrombosis correlation with venous pressure measurements and implications for treatment and prognosis. Am J Neuroradiol 1995 16 1021-1029. 

Horowitz M, Purdy P, Unwin H, Carstens G, Greenlee R, Hise J, Kopitnik T, Batjer H, Rollins N, Samson D. Treatment of dural sinus thrombosis using selective catheterization and urokinase. Ann Neurol 1995 38 58-67. 

Di Rocco C, lannelli A, Leone G, Moschini M, Valori VM. Heparin-urokinase treatment in aseptic dural sinus thrombosis. Arch Neurol 1981 38 431 35. 

Smith TP, Higashida RT, Barnwell SL, Halbach VV, Dowd CF, Fraser KW, Teitelbaum GP, Hieshima GB. Treatment of dural sinus thrombosis by urokinase infusion. Am J Neuroradiol 1994 15 801-807. 

A 63-year-old man taking long-term lithium for a schizoaffective disorder developed a dural sinus thrombosis and severe hypernatremia and died (616). 

The authors suggested that the sequence of events was lithium-induced nephrogenic diabetes insipidus resulting in hypernatremia followed by the dural sinus thrombosis. 

Kamijo Y, Soma K, Hamanaka S, Nagai T, Kurihara K. Dural sinus thrombosis with severe hypernatremia developing in a patient on long-term lithium therapy. J Toxicol Clin Toxicol 2003 41 359-62. 

Table 18.1. Time dependant MR signal pattern in intraparen-chymal hemorrhage and thrombosed dural sinuses. [Modified from Gomori et al. 1985 Isensee et al. 1994)...

Chronic thrombosis or only partially recanalized dural sinus thrombosis may be diagnosed in these patients (Thron et al. 1986 Wessel et al. 1987). This type is less obvious on the static MRI (Isensee et al. 1994) and requires MR venography, if possible in a contrast-enhanced technique. In children, purulent mastoiditis is an important cause of septic thrombosis (Reul et al. 1997) or... 

Fig. 18.11. 3D PC MR venography. There is only minimal flow in the area of the left transverse sinus. As these images do not give any anatomical information the evaluation must include images (CT or MRI) which provide the information whether this dural sinus is present and occluded or whether it is hypo-/aplastic...

CT venography of cerebral veins is a very reliable technique for the demonstration of intraluminal abnormalities of dural sinuses (Figs. 18.10a, 18.12a Ozsvath et al. 1997). In particular, multisection CT venography with subtraction of bone is a promising and competitive technique for the evaluation of veno-occlusive disorders of the cerebral veins and sinuses (Majoie et al. 2004). One disadvantage, however, is the radiation exposure. Conventional DSA is typically not needed unless endovascular treatment is necessary, since MRI, MRA and CT are usually sufficient to make a correct diagnosis. 

Fig. 18.12. Circumscript filling defects within a dural sinus, a Incidental finding in contrast-enhanced CT. The bilateral well-defined filling defects in the lateral sinuses (arrows) most probably represent Pacchioni granulations, b Contrast-enhanced Tl-weighted image with incidentally demonstrated hypointense, round and circumscript structures within the lateral sinus (arrow). They most likely represent hypertrophic Pacchioni granulations and not thrombus, c In the T2-weighted images of the same patient the structures appear strongly hyperintense (arrow)...

Krings T, Hans FJ (2004) New developments in MRA time-resolved MRA. Neuroradiology 46 [Suppl 2] 214-222 Kudo K, Terae S, Ishii A, Omatsu T, Asano T, Tha KK, Miyasaka K (2004) Physiologic change in flow velocity and direction of dural venous sinuses with respiration MR venography and flow analysis. AJNR 25 551-557 Kiiker W, Mull M, Mayfrank L, Weis J, Schiefer J, Thron A (1997) A cystic lesion within the dural sinuses a rare cause of increased intracranial pressure. Neuroradiology 39 132-135... 

Vogel TJ, Bergman C, Villringer A, Einhaupl K, Lissner J, Felix R (1994) Dural sinus thrombosis value of venous MR angiography for diagnosis and follow-up. Am J Roentgenol 162 1191-1198... 

The venous anatomy is very variable. Venous blood flows centrally via the deep cerebral veins and peripherally via the superficial cerebral veins into the dural venous sinuses, which lie between the outer and meningeal inner layer of the dura and drain into the internal jugular veins (Stam 2005) (Fig. 4.4). The cerebral veins do not have valves and are thin walled, and the blood flow is often in the same direction as in neighboring arteries. There are numerous venous connections between the cerebral veins and the dural sinuses, the venous system of the meninges, skull, scalp, and nasal sinuses, allowing infection or thrombus to propagate between these vessels. 

Intracranial vascular malformations are uncommon, probably congenital, and sometimes familial (Byrne 2005). Those in the dura, draining into the sinuses rather than cerebral veins, can also be caused by skull fracture, craniotomy or dural sinus thrombosis. The overall intracranial vascular malformations detection rate is approximately 3 per 100 000 population per annum and the prevalence is about 20 per 100 000 (Brown et al. 1996). 

Thrombosis in the dural sinuses or cerebral veins is much less common than cerebral arterial thromboembolism. It causes a variety of clinical syndromes, which often do not resemble stroke (Bousser and Ross Russell 1997). While ischemic arterial stroke and cerebral venous thrombosis share some causes (Southwick et al. 1986), others are specific to cerebral venous thrombosis (Table 29.1). A particularly high index of suspicion is required in women on the oral contraceptive pill (Saadatnia and Tajmirriahi 2007) and in the puerperium. In the past, cerebral venous thrombosis was strongly associated with otitis media and mastoiditis, lateral sinus thrombosis or otitic hydrocephalus, but the most common causes are now pregnancy and the puerperium, which cause 5-20% of the cerebral venous thrombosis in the developed world, the oral contraceptive pill, malignancy, dehydration, inflammatory disorders and hereditary coagulation disorders. No cause is found in around 20% of cases. 

Tumor invasion of dural sinus (malignant meningitis, lymphoma skull base secondary, etc)... 

The posterior cerebral artery supplies the occipital lobe and portions of the medial and inferior temporal lobe. The arterial supply of the spinal cord is derived from the vertebral arteries and the radicular arteries. The brain is supplied by the internal carotid arteries (the anterior circulation) and the vertebral arteries, which join at the pon tomedullary junction to form the basilar artery (collectively termed the posterior circulation). The brainstem is supplied by the posterior system. The medulla receives blood from branches of the vertebral arteries as well as from the spinal arteries and the posterior inferior cerebellar artery (PICA). The pons is supplied by paramedian and short circumferential branches of the basilar artery. Two major long circumferential branches are the anterior inferior cerebellar artery (AICA) and the superior cerebellar artery. The midbrain receives its arterial supply primarily from the posterior cerebral artery as well as from the basilar artery. The venous drainage of the spinal cord drains directly to the systemic circulation. By contrast, veins draining the cerebral hemispheres and brain stem drain into the dural sinuses. Cerebrospinal fluid also drains into the dural sinuses through unidirectional valves termed arachnoid villi. 

DAVMs are frequently associated with stenosis or occlusion of the draining dural sinuses. 

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