Sinus thrombosis

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. 

Orbital cellulitis or abscess, periorbital cellulitis, meningitis, cavernous sinus thrombosis, ethmoid or frontal sinus erosion, chronic sinusitis, and exacerbation of asthma or bronchitis... 

Thromboembolism, thrombotic and thrombophlebitic events, including sagittal sinus thrombosis and life-threatening or fatal strokes have been reported. 

A 26-year-old woman developed severe aplastic anemia, complicated by superior sagittal sinus thrombosis, while taking fluoxymesterone 30 mg/day (49). 

Kaito K, Kobayashi M, Otsubo H, Ogasawara Y, Sekita T, Shimada T, Hosoya T. Superior sagittal sinus thrombosis in a patient with aplastic anemia treated with anabolic steroids. Int J Hematol 1998 68(2) 227-9. 

Cerebral sinus thrombosis, progressing to hemorrhagic cerebral infarction, occurred in a 52-year-old woman (32). 

Finelli PF, Schauer PK. Cerebral sinus thrombosis with tamoxifen. Neurology 2001 56(8) l 113—4. 

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. 

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... 

On the other hand, thrombus characteristics as discussed above might also mask the presence of an acute CVST since the hypointense visualization of acute thrombus (< 3 days) on T2-weighted sequences might be mistaken as a flow void (Fig. 18.3). The same is true for old organized or partially recanalized sinus thrombosis (Fig. 18.9). 

Strupp M, Villringer A, Bousser MG (2003) Cerebral venous and sinus thrombosis. In Brandt T, Caplan LR, Dichgans J, Diener HC, Kennard C (eds) Neurological disorders, course and treatment, 2nd edn. Academic, New York, pp 447-460... 

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... 

Dehydration, secondary to lithium-induced nephrogenic diabetes insipidus, was thought to be the cause of a superior sagittal sinus thrombosis in a 30-year-old woman who presented with confusion, papilledema, and a left hemiparesis (336). 

Wasay M, Bakshi R, Kojan S, Bobustuc G, Dubey N. Superior sagittal sinus thrombosis due to lithium local urokinase thrombolysis treatment. Neurology 2000 54(2) 532-3. 

Neurological involvement in Behcet s disease may be subclassified into two major forms a vascular-inflammatory process with focal or multifocal parenchymal involvement and a cerebral venous sinus thrombosis with intracranial hypertension. The vasculitis and meningitis may affect cerebral arteries, particularly in the posterior circulation, to cause ischemic stroke and possibly intracranial hemorrhage (Farah et al. 1998 Krespi et al 2001 Siva et al. 2004 Borhani Haghighi et al. 2005). 

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. 

Fig. 29.1. A CT brain scan from a young woman with superior sagittal sinus thrombosis showing the "empty delta sign" - a triangular pattern of enhancement surrounding a central relatively hypodense area of thrombosis (arrow).

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