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PubMed2006

A caution regarding the use of low-molecular weight heparin in pediatric otogenic lateral sinus thrombosis.

Lateral sinus thrombosis (LST), a rare complication of otitis media, is managed by antibiotics, surgery and anticoagulation. Traditionally, post-operative anticoagulation has been achieved by intravenous unfractionated heparin followed by oral warfarin. Fractionated, or low-molecular weight heparin derivatives (LMWH) have been introduced recently. There has been minimal literature to date regarding their use for the management of LST. We present use of the LMWH enoxaparin (Lovenox) for otogenic LST in two children, both of whom experienced hemorrhagic complications. On this basis and in the context of a literature review, we urge caution when using LMWH for pediatric otogenic LST.

Adolescent↗
PubMed2001

Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. For The Cerebral Venous Sinus Thrombosis Study Group.

The prognosis of cerebral venous sinus thrombosis (CVST) is variable, and outcome may range from complete recovery to death. Prognostic factors to predict outcome in the acute phase of CVST have not been analysed in a prospective study. Prognostic factors in patients enrolled in a clinical treatment trial were prospectively investigated. Poor outcome after 12 weeks, defined as death or dependency (Oxford handicap score > or =3), was used as the principle outcome measure. Univariate relations between possible prognostic factors and outcome at 12 weeks were analyzed with chi(2) tests. Treatment and all factors associated with prognosis (p< or = 0.25) were forced into a logistic regression model with a forward selection procedure. Fifty nine patients (50 women, nine men) were studied, with a mean age of 37 years (range 18 to 80 years). After 12 weeks 10 patients (17%) had a poor outcome. The univariate identified factors related to poor outcome were papilloedema, altered consciousness, coma, age older than 33 years, diagnostic delay < or =10 days, intracerebral haemorrhage, and involvement of the straight sinus. Isolated intracranial hypertension and a delta sign on CT were associated with good outcome. In the multivariate analysis coma and cerebral haemorrhage were significantly associated with a poor outcome, with odds ratios of 8.2 (95% confidence interval (95% CI) 1. 3-50.1) and 20.7 (95% CI 1.6-264.3) respectively. Involvement of the straight sinus was also weakly, but not significantly, associated with poor outcome. In conclusion, coma and intracerebral haemorrhage are independent predictors for poor outcome of CVST.

Adolescent↗
PubMed1991

[Neonatal dural sinus thrombosis].

Neonatal dural sinus thrombosis is a relatively unknown disease. We recently diagnosed two newborn patients with dural sinus thrombosis. Both patients had associated conditions known to predispose to dural sinus thrombosis. One patient had severe perinatal asphyxia, and the other patient had a deficiency of antithrombin III. Both patients had severe neonatal seizures. The literature on some aspects of this entity is discussed. It is concluded that dural sinus thrombosis may represent an important and underrecognized cause of neonatal seizures.

Antithrombin III Deficiency↗
PubMed1998

Subdural empyema and blindness due to cavernous sinus thrombosis in acute frontal sinusitis.

In this era of antibiotics, the complications of acute sinusitis are much less frequently encountered. Although orbital complications are most common, intracranial complications carry a high rate of mortality and morbidity. We describe a case of acute frontal sinusitis with subdural empyema and blindness due to cavernous sinus thrombosis and carotid artery thrombosis with a discussion of treatment of these complications and the etiology of blindness in sinusitis.

Acute Disease↗
PubMed2001

Pre-eclampsia: a predisposing factor for neonatal venous sinus thrombosis?

Neonatal venous sinus thrombosis is a well-recognized, but infrequently diagnosed, cause of neonatal encephalopathy. Previous reports have tended to omit reference to the importance of maternal factors in predisposing the infant to this condition. This report, in which eight patients with neonatal venous sinus thrombosis are presented, will reveal a strong association between pre-eclampsia, prothrombotic disorders, and neonatal venous sinus thrombosis. Contrary to previously published reports, there is a high likelihood of neurodevelopmental residua after this condition.

Adult↗
PubMed2000

Cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis is a challenging condition because of its variability of clinical symptoms and signs. It is very often unrecognised at initial presentation. All age groups can be affected. Large sinuses such as the superior sagittal sinus are most frequently involved. Extensive collateral circulation within the cerebral venous system allows for a significant degree of compensation in the early stages of thrombus formation. Systemic inflammatory diseases and inherited as well as acquired coagulation disorders are frequent causes, although in up to 30% of cases no underlying cause can be identified. The oral contraceptive pill appears to be an important additional risk factor. The spectrum of clinical presentations ranges from headache with papilloedema to focal deficit, seizures and coma. Magnetic resonance imaging with venography is the investigation of choice; computed tomography alone will miss a significant number of cases. It has now been conclusively shown that intravenous heparin is the first-line treatment for cerebral venous sinus thrombosis because of its efficacy, safety and feasability. Local thrombolysis may be indicated in cases of deterioration, despite adequate heparinisation. This should be followed by oral anticoagulation for 3-6 months. The prognosis of cerebral venous sinus thrombosis is generally favourable. A high index of clinical suspicion is needed to diagnose this uncommon condition so that appropriate treatment can be initiated.

Anticoagulants↗
PubMedDate not supplied

Management of otogenic lateral sinus thrombosis.

PURPOSE: Lateral sinus thrombosis (LST) is a rare but potentially devastating complication of otitis media. We review the clinical presentation, evaluation, management, operative findings, and outcomes of this serious complication. MATERIAL AND METHODS: A retrospective chart review was performed at a teaching hospital of all patients diagnosed with an otogenic lateral sinus thrombosis between 1992 and 2002. Data on patients with otogenic LST were collected and analyzed. RESULTS: Eleven patients were identified with a diagnosis of lateral sinus thrombosis, and all had a chronic otitis media. The most common presenting symptoms were headache, otalgia, and fever. Radiologic evaluation included computed tomography scan, magnetic resonance imaging, or magnetic resonance venography. All patients had radiographic evidence of LST preoperatively. The thrombosed sinus was on the right side in 6 patients and on the left side in 5 patients. The majority of patients (8 of 11) had a second concomitant intracranial complication. All patients underwent a mastoidectomy. The thrombus was removal in 7 cases, whereas only needle aspiration of the sinus was performed in 4 cases. Gram-negative bacilli and anaerobes were the most common organisms. There were no deaths but sequelae included VI nerve palsy, ataxia, and dead ear. CONCLUSION: LST as a complication of otogenic infections may still pose a serious threat that warrants immediate attention and care. It is frequently associated with other intracranial complications. Contrast-enhanced computed tomography scan and magnetic resonance imaging plays a major role in determining diagnosis and treatment plans. The availability of broad-spectrum antibiotics has improved our management significantly. Conservative surgical intervention including eradication of all perisinus infection and needle aspiration of the sinus seems to be effective.

Adolescent↗
PubMed2004

Diabetic ketoacidosis presenting as a cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis is an uncommon condition with a variable clinical presentation, often resulting in a delayed diagnosis. The most common risk factors are pregnancy and puerperium, oral contraceptive use, head injury, dehydration, blood dyscrasias, malignancies, and systemic diseases. We present a nineteen-year-old female in whom a superior sagittal sinus thrombosis was caused by dehydration during diabetic ketoacidosis and led to the diagnosis of new-onset type 1 diabetes mellitus. To our knowledge this is the first published report of a cerebral venous sinus thrombosis in association with diabetic ketoacidosis in an adult.

Adult↗
PubMed1988

[Sequential magnetic resonance images of a case of cerebral sinus thrombosis--imaging of the thrombosed sinus and its recanalization].

Magnetic resonance images of a case of superior sagittal sinus thrombosis before and after complete recanalization are presented. The patient was a 61-year-old man with two days history of intermittent right hemiconvulsion followed by post-ictal hemiplegia. Mild erythrocytosis was noted on admission. CT scans revealed left frontal hemorrhagic infarction with empty delta sign in the middle portion of the superior sagittal sinus. Left carotid angiogram showed occlusion of two frontal cortical veins and retrograde filling of these veins into the cavernous sinus. Lack of filling of the middle and anterior part of the superior sagittal sinus was noted. These studies led to the diagnosis of superior sagittal sinus thrombosis associated with hemorrhagic infarction. He was treated with intravenous infusion of low molecular dextran and venesection. Neither heparin, urokinase, hyperosmolar solutions nor steroids were used because of the presence of hemorrhagic infarction and of the lack of signs of increased intracranial pressure. He completely recovered neurologically and recanalization of the superior sagittal sinus was confirmed angiographically eight weeks after the onset. Magnetic resonance images were taken with a Siemens 1.5 T Magnetom scanner using spin-echo pulse sequences. A T 1-weighted mid-sagittal magnetic resonance image ten days after the onset showed hyperintensity in the middle part of the superior sagittal sinus which corresponded to the thrombus. Both T 1 and T 2 weighted coronal images revealed a small area of hypointensity indicating the existence of residual blood flow in the superior sagittal sinus in addition to the thrombus both in the sinus and in the cortical vein.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Arteries↗
PubMed1986

Gallium scintigraphy in a case of septic cavernous sinus thrombosis.

Septic cavernous sinus thrombosis, a relatively uncommon disease entity, frequently can be fatal. Early diagnosis is imperative in order that appropriate treatment be instituted. A 59-year-old woman who was admitted to our institution with complaints of diplopia, blurred vision and fevers that developed following a tooth extraction is presented. Initial CT and lumbar puncture on the day of admission were totally normal. A repeat CT performed 48 hours after admission, on the same day as gallium imaging, demonstrated findings consistent with cavernous sinus thrombosis. Gallium imaging demonstrated intense uptake in the left cavernous sinus and left orbit as well as moderately increased activity in the right cavernous sinus and orbit, confirming infection. The patient was treated with antibiotics, and repeat CT and gallium imaging were performed ten days later, both of which demonstrated near total resolution of the disease process. Conceivably, if gallium imaging had been initiated on the day of admission it may have been the first study to demonstrate an infectious process in the cavernous sinus. Gallium imaging should be considered as a diagnostic tool in the noninvasive workup of this entity.

Bacterial Infections↗
PubMed2006

Headache with unilateral pulsatile tinnitus in women can signal dural sinus thrombosis.

OBJECTIVES: Dural sinus thrombosis commonly presents with headache, and rarely with tinnitus. These thromboses can progress to neurologic impairment and death. We are sharing recent clinical experiences with these thromboses as they present to the otologist. METHODS: We report the presentation, physical examination, and imaging studies of 4 patients. RESULTS: Four women had thrombotic occlusion of the sigmoid sinus. Their only symptoms were focal headache in all 4 patients, and unilateral pulsatile tinnitus in 2 of them. Imaging studies had to be repeated or alternative testing performed in order to conclusively identify the problem. CONCLUSIONS: It is important to be vigilant for the possibility of sigmoid sinus thrombosis in women who complain of unilateral head pain or unilateral pulsatile tinnitus. Appropriate imaging must be performed.

Adult↗
PubMed1991

Cerebral dural sinus thrombosis.

Cerebral dural sinus thrombosis is an unusual syndrome in which a patient presents with a severe headache that may be associated with diverse neurologic and physical findings. The case of a 31-year-old woman with headache, vomiting, generalized tonic-clonic seizure, and subsequent dense hemiplegia is presented. The patient was diagnosed as having a cerebral dural sinus thrombosis, but only after the diagnosis was missed initially. The syndrome may be difficult to detect because it can mimic several other entities. There are several known or suspected predisposing factors. The syndrome, diagnostic modalities, and therapeutic options are reviewed.

Adult↗
PubMed2006

Subarachnoid haemorrhage as a presentation of cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis can present with a variety of clinical symptoms ranging from isolated headache to deep coma. Subarachnoid haemorrhage is a rare presentation. In the report, we describe a case of non-puerperal venous thrombosis of many dural sinuses manifesting on imaging solely as localized subarachnoid haemorrhage without underlying parenchymal involvement.

Adult↗
PubMed1997

Cavernous sinus thrombosis: a rare complication of sinusitis.

Intracranial complications of sinusitis are infrequent since the advent of antibiotics, and furthermore the prognosis is improved by medical therapy. We have seen a patient with an intracranial complication of sinus infection that had a history of frontal bone trauma five years ago. Then following an upper respiratory tract infection, headache, bilateral periorbital pain and swelling, spiking fever, neck stiffness, bilateral chemosis and ophthalmoplegy developed. Cavernous sinus thrombosis was diagnosed clinically and high doses of I.V. antibiotics were started promptly. The patient's condition improved in the first week of her admission. She was discharged three weeks later, without any surgical intervention. Two-year follow up showed no cranial nerve palsies or any neurologic deficiencies. A good result has been achieved by immediate medical measures.

Cavernous Sinus↗
PubMed1984

Septic cavernous sinus thrombosis.

Septic cavernous sinus thrombosis remains a potentially lethal disease, although advances in therapy have lowered the morbidity and mortality substantially. Prevention, early diagnosis, and aggressive treatment offer the best hope for recovery.

Adult↗