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At least 469 records · Page 26Linked to original sources
PubMed1995

Cavernous sinus thrombosis: a report of eight consecutive comatose patients.

Septic thrombosis of the cavernous sinus is a severe and lethal condition if left untreated. The mortality is particularly high in those patients admitted in a comatose state. Eight patients treated successfully in Bulawayo, Zimbabwe in Mpilo Central Hospital over a period of three years are reported. In the discussion, emphasis is placed on the treatment of raised intracranial pressure in this particular group of patients and early treatment with appropriate antibiotics. Clinicians must be aware of this serious complication of infections around the face and must treat them early and aggressively.

Adolescent↗
PubMed1996

Sigmoid sinus thrombosis associated with internal jugular venous occlusion: direct thrombolytic treatment.

PURPOSE: To report our experience with transfemoral direct venous thrombolysis and angioplasty to treat central venous and dural sinus occlusion. The cases presented are rare examples of internal jugular occlusion associated with sigmoid sinus thrombosis. METHODS AND RESULTS: Two middle-aged, symptomatic female patients were diagnosed with sigmoid sinus and internal jugular vein thrombosis. Venography was performed from a contralateral transfemoral approach, followed immediately by urokinase infusion directly to the occlusion using an intermittent "burst-bolus" technique. Successful thrombolysis of the sigmoid sinus and internal jugular vein was documented in both patients. In one case, a venous stenosis was treated with balloon angioplasty. Clinical signs and symptoms resolved in both patients. CONCLUSIONS: Occluded dural sinuses and central veins can be treated with direct administration of thrombolytic agents. When an underlying stenosis is identified, balloon dilation should be used to reduce the likelihood of recurrence.

Adult↗
PubMed2001

Loco-regional thrombolysis in the treatment of cerebral venous and sinus thrombosis: report of two cases.

Although intravenous (i.v.) heparin is widely used as the first line treatment for cerebral venous and sinus thrombosis (CVST), the most appropriate therapy for this disease is still controversial. We report 2 cases of CVST who were successfully treated by means of loco-regional thrombolysis with urokinase. In the first case we chose this treatment instead of i.v. heparin because clinical conditions of the patient appeared critical for life on hospital admission; in the second case loco-regional thrombolysis was performed because a full-dose heparin treatment over 8 days failed to improve the clinical picture of the patient. In the literature, there are no established criteria for the use of loco-regional thrombolysis in CVST. On the basis of our own experience and few previous reports on the matter, we suggest that loco-regional thrombolysis should be considered an appropriate treatment for CVST when patients are at life risk, when an involvement of deep cerebral veins is present or when, after full heparinization, patients are doing poorly clinically.

Cerebral Angiography↗
PubMed2003

Fatal dural sinus thrombosis associated with heterozygous factor V Leiden and a short activated partial thromboplastin time.

Inherited thrombophilia is a risk factor for dural sinus thrombosis (DST). To our knowledge, this is the first description with autopsy findings of a patient with DST associated with heterozygous factor V Leiden and a short activated partial thromboplastin time (aPTT). A 51-year-old woman presented with a 3-day history of headache, nausea, right-sided weakness, and focal motor seizure; she died 3 days after admission. At autopsy, a gross examination showed hemorrhage of bilateral parietal lobes and left primary motor cortex, uncal and tonsillar herniation, and pulmonary embolus of the right upper lobe. A microscopic examination of the brain showed an organizing thrombus in the superior sagittal sinus, diffuse cerebral edema, and extensive venous congestion. Laboratory studies showed heterozygous factor V Leiden by polymerase chain reaction and a very short aPTT of 17 seconds (reference range, 22-30 seconds). The combination of a heterozygous factor V Leiden mutation and a short aPTT may have contributed to the fatal DST in this patient.

Factor V↗
PubMed2005

Cerebral venous sinus thrombosis presenting with excessive subarachnoid hemorrhage in a 14-year-old boy.

Cerebral venous thrombosis presenting with subarachnoid hemorrhage (SAH) is very rare. We report a case of cerebral venous sinus thrombosis as an initial manifestation of SAH. A 14-year-old boy was admitted with progressive headache, nausea, vomiting, diplopia, and gait disturbance. Cerebral computed tomography scan showed a widely SAH in the basal cisterns, bilateral sylvian fissures, and anterior interhemispheric fissure. Cerebral angiography was performed to detect any aneurysm in intracranial vasculature as a cause of SAH; however, the totally thrombosed superior sagittal sinus, galenic vein, and straight sinus were the sole abnormal findings.

Adolescent↗
PubMed2003

[Unilateral exophthalmos during the course of cavernous sinus thrombosis: a case report].

Ophthalmopathy, particularly its infiltrative form, is considered a characteristic feature of Graves' disease. However many other also life-treating conditions may be manifested as unilateral exophthalmos and lead to diagnostic problems. A case of a sixty six-year old patient with asymmetric exophthalmos and rapidly decreasing vision acuity is reported. Thyroid eye disease was suspected due to clinical symptoms (diplopy, impaired right eye motion) and thickening of extraocular muscles in ultrasound imaging. Further follow-up and orbits as well as head MRI imaging led to the final diagnosis of cavernous sinus thrombosis, complication of acute maxillary sinusitis.

Aged↗
PubMed1993

Pseudotumor cerebri secondary to dural sinus thrombosis in neurosarcoidosis.

Pseudotumor cerebri as a presenting manifestation of neurosarcoidosis is rare. This case reported herein had pseudotumor cerebri secondary to dural sinus thrombosis as a presenting feature of neurosarcoidosis without known systemic sarcoidosis. Proper systemic steroid therapy resulted in ocular and systemic recovery. Neurosarcoidosis should be considered in the differential diagnosis of pseudotumor cerebri in patients with unusual neurological findings.

Adult↗
PubMed1999

Use of mechanical thrombolysis via microballoon percutaneous transluminal angioplasty for the treatment of acute dural sinus thrombosis: case presentation and technical report.

OBJECTIVE AND IMPORTANCE: Although conventional superselective chemical thrombolysis is frequently successful for the treatment of severe acute dural sinus thrombosis, the technique has limitations and risks. This prompted us to develop a supplemental technique for achieving more rapid recanalization, using coronary microballoon percutaneous transluminal angioplasty catheters. We describe a successful application of this technique and technology that has not been previously reported. CLINICAL PRESENTATION: After several days of severe headaches, photophobia, and vomiting, a 29-year-old woman presented with rapidly progressive neurological deficits secondary to complete occlusion of the superior sagittal sinus (SSS) and right transverse/sigmoid sinus complex. Owing to her rapid neurological decline, she was referred for emergency endovascular intervention. TECHNIQUE: Initially, superselective chemical thrombolysis of the SSS was performed using urokinase. However, because of the extensive nature of the thrombus and lack of initial therapeutic response, we elected to attempt mechanical thrombolysis with various coronary percutaneous transluminal angioplasty microballoon catheters. This was accomplished by initial coaxial positioning of the device into an occluded segment, followed by gentle inflation and retraction of the device along the course of the right transverse sinus and/or SSS. These maneuvers were repeated with balloons of increasingly large diameter. Near-complete restoration of venous outflow was obtained within the SSS with preferential runoff into the left transverse sinus. The right transverse sinus was only partially recanalized. Despite the patient's rapid neurological decline on presentation, she experienced a dramatic clinical recovery with near-complete reversal of neurological deficits within 24 hours of intervention. CONCLUSION: This report shows the feasibility of performing safe and effective mechanical thrombolysis with percutaneous transluminal angioplasty coronary balloon microcatheters within the major dural sinuses. This technique can probably accelerate clot disruption and thrombolysis, possibly resulting in a more rapid restoration of venous flow.

Acute Disease↗
PubMed2001

Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis.

BACKGROUND AND PURPOSE: We sought to compare the safety and efficacy of direct urokinase thrombolysis with systemic heparin anticoagulation for superior sagittal sinus thrombosis (SSST). METHODS: At University at Buffalo (NY) and University of Texas (Dallas, Houston), we reviewed 40 consecutive patients with SSST, treated with local urokinase (thrombolysis group) or systemic heparin anticoagulation (heparin group). The thrombolysis group (n=20) received local urokinase into the SSS followed by systemic heparin anticoagulation. The heparin group (n=20) received systemic heparin anticoagulation only. Neurological dysfunction was rated as follows: 0, normal; 1, mild (but able to ambulate and communicate); 2, moderate (unable to ambulate, normal mentation); and 3, severe (unable to ambulate, altered mentation). RESULTS: Age (P=0.49), sex (P=0.20), baseline venous infarction (P=0.73), and predisposing illnesses (P=0.52) were similar between the thrombolysis and heparin groups. Pretreatment neurological function was worse in the thrombolysis group (normal, n=5; mild, n=8; moderate, n=4; severe, n=3) than in the heparin group (normal, n=8; mild, n=8; moderate, n=3; severe, n=1) (P=NS). Discharge neurological function was better in the thrombolysis group (normal, n=16; mild, n=3; moderate, n=1; severe, n=0) than in the heparin group (normal, n=9; mild, n=6; moderate, n=5; severe, n=0) (P=0.019, Mann-Whitney U test). Hemorrhagic complications were 10% (n=2) in the thrombolysis group (subdural hematoma, retroperitoneal hemorrhage) and none in the heparin group (P=0.49). Three of the heparin group patients developed complications of the underlying disease (status epilepticus, hydrocephalus, refractory papilledema). No deaths occurred. Length of hospital stay was similar between the groups (P=0.79). CONCLUSIONS: Local thrombolysis with urokinase is fairly well tolerated and may be more effective than systemic heparin anticoagulation alone in treating SSST. A randomized, prospective study comparing these 2 treatments for SSST is warranted.

Adult↗
PubMed1996

Sagittal sinus thrombosis in adult minimal change nephrotic syndrome.

Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. The mechanisms are as yet unclear, but numerous alterations in coagulant and anti-coagulant factors have been reported [Llach et al. 1985, Harris and Ismail 1994]. The most common clinical features in adults are renal vein thrombosis, femoral vein thrombosis and pulmonary embolism, although thrombosis in numerous other arterial and venous sites has been described [Cameron 1984, Llach et al. 1985]. Intracranial thrombosis is rare, although in adult nephrotic syndrome arterial thrombosis is well recognized [Fuh et al. 1991]. We report a patient with minimal change nephrotic syndrome who developed venous sinus thrombosis detected by magnetic resonance (MR) scanning.

Adult↗
PubMed1990

"Pseudo-delta sign" on computed tomography in an extremely acute stage of superior sagittal sinus thrombosis--a case report.

A case of superior sagittal sinus (SSS) thrombosis with a "pseudo-delta sign" on computed tomography (CT) is reported. The so-called "empty delta sign," which usually appears following contrast enhancement, is reliable in the CT diagnosis of SSS thrombosis but may not appear, it is said, in the extremely acute stage. In this patient, however, the "empty delta sign" appeared with precontrast CT scans and disappeared with postcontrast CT scans, "pseudo-delta sign," in the extremely acute stage of SSS thrombosis. On the precontrast CT, blood surrounding the sagittal sinus outlined it; when contrast was given, it became dense with blood.

Acute Disease↗
PubMed1996

Superior sagittal sinus thrombosis in a child with nephrotic syndrome.

A 3-year-old male with steroid-responsive nephrotic syndrome developed a rare complication, sagittal sinus thrombosis during an episode of gastroenteritis, while on steroid therapy. Anticoagulation, as assessed by partial thromboplastin time, was difficult to maintain, despite administering high doses of heparin, infusions of fresh-frozen plasma to provide antithrombin III, and, subsequently, maximum doses of warfarin (0.3 mg/kg per day). Despite these problems the child made a complete neurological recovery.

Anti-Inflammatory Agents↗
PubMed2003

Neurological and cognitive long-term outcome in patients with cerebral venous sinus thrombosis.

OBJECTIVES: The main aim of the present study was to assess long-term neurological and cognitive outcome in patients with cerebral venous sinus thrombosis (CVST). METHODS: We re-investigated by means of a face to face interview all patients with a confirmed diagnosis of CVST, collected at our Department over the years 1990-2000. During the interview the presence of headache, epileptic seizures, visual deficits and a new episode following the first occurrence of CVST were checked. Moreover all patients underwent a neurological examination, a functional evaluation, a cognitive assessment to rule out aphasia, apraxia and working memory deficits. Depression of mood was also investigated. RESULTS: On the whole 34 patients entered the study: 10 patients referred episodic headache following the disease. In three cases epileptic seizures were present. A new event occurred in only one patient. Four patients showed pyramidal signs, in two cases visual deficits were present. All patients had no functional disability. We found a mild non-fluent aphasia in three patients, working memory deficits in six patients and depression of mood in six cases. CONCLUSION: The present study demonstrates a good neurological and cognitive long-term outcome in patients with CVST.

Adult↗
PubMed1998

[Neonatal Streptococcus pyogenes meningitis and sagittal sinus thrombosis: case report].

We report a case of Streptococcus pyogenes meningitis in a 18 days year-old-girl with clinical course complicated by sagittal sinus thrombosis. Some aspects of the pathogenesis, treatment and follow-up of the disease are discussed. The world increase of serious streptococcal infections in the last 10 years, probably will become neonatal Streptococcus pyogenes meningitis more frequent in the future and it is important to be alert for the precocious diagnosis and the possible complications of that potentially lethal infection.

Female↗