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PubMed1983

Lateral sinus thrombosis.

The incidence of lateral sinus thrombophlebitis has been significantly reduced since the advent of antibiotics. This entity is rarely encountered in clinical practice, so a high index of suspicion is essential for early diagnosis and appropriate management. Although uncomplicated dural venous thrombosis carries an excellent prognosis with proper treatment, delay in diagnosis and institution of appropriate therapy may lead to serious, or even fatal, consequences. It is hoped that this case report and discussion will serve to increase the awareness of lateral sinus thrombophlebitis as a potential complication of suppurative otitis media.

Abscess↗
PubMed1976

Aseptic cavernous sinus thrombosis after internal carotid arterial occlusion in polycythaemia vera.

Two patients with untreated polycythaemia vera developed intracranial internal carotid arterial occlusion followed by monocular blindness and the characteristic features of ipsilateral cavernous sinus thrombosis. Primary septic source and signs of systemic infection were absent. It is suggested that the predisposing factors in this unusual syndrome were hyperviscosity and venous sludging induced by the basic haematological disorder and progression of the thrombotic process within the internal carotid artery towards its intracavernous portion with occlusion of the ophthalmic artery and of the arterial branches which supply the walls of the sinus.

Adult↗
PubMed1992

Bilateral acute mastoiditis complicated by lateral sinus thrombosis.

A case of bilateral mastoiditis with subperiosteal abscesses complicating acute otitis media in a two and a half year old girl is presented. Contrast enhanced computerized tomography confirmed the diagnosis of right lateral sinus thrombosis. The aetiology, diagnosis and management of these conditions are discussed.

Abscess↗
PubMed1992

Homocystinuria presenting as sagittal sinus thrombosis.

Thrombotic and thromboembolic complications are the main causes of morbidity and mortality in patients with homocystinuria. However, it is unusual for thrombosis to be the single clinical feature leading to investigation for homocystinuria. We report an academically superior teenage boy who presented with sagittal sinus thrombosis, papilledema, transient right hemiparesis, and pneumothoraces. Pyridoxine-unresponsive homocystinuria was diagnosed by aminogram, enzyme assay, and clinical trial. Treatment has been with methionine restriction and betaine. Homocystinuria should be considered in patients with unusual vascular lesions or premature thromboembolism.

Adolescent↗
PubMed2004

Cerebral venous and sinus thrombosis: patients with a fatal outcome during intravenous dose-adjusted heparin treatment.

INTRODUCTION: Although anticoagulation (AC) reduces the risk of a fatal outcome or severe disability in patients with cerebral venous and sinus thrombosis (CVST), prognosis of severe cases is still difficult to predict. The authors studied the clinical course of patients with CVST who died despite AC therapy to look for clinical features that might explain the lethal course of these patients. MATERIALS AND METHODS: Retrospective analysis of a series of 79 consecutive patients with CVST who were treated with a standard regimen of dose-adjusted iv heparin. Case histories of patients with a fatal outcome are presented. RESULTS: The authors identified eight patients with a fatal outcome. All patients were stuporous or comatose at the start of AC, and four patients showed markedly delayed intracranial circulation times, indicating extensive venous thrombosis. Two patients improved, but deteriorated secondarily after reduction or discontinuation of AC. Sufficient activated partial thromboplastin time levels were reached only after a delay in three patients, and critical deterioration occurred in two of them during this time. CONCLUSION: Although inadequate AC may have contributed to the fatal outcome, some patients with extensive venous thrombosis who are stuporous or comatose at the start of AC may carry an increased risk of death, despite heparin therapy. More aggressive treatment approaches, such as endovascular thrombolysis, may be needed for this subgroup of patients with CVST.

Adult↗
PubMed2006

Thrombolytic therapy in cerebral venous sinus thrombosis.

The use of thrombolytic agents to rapidly lyse the clot has emerged as a therapeutic modality, in concert with interventional neuroradiologic approaches to deliver the agent locally at the site of thrombosis. There are no randomized, double blind, placebo, controlled trials to support thrombolysis as a first line therapy in patients with cerebral venous sinus thrombosis compared to standard therapy using anticoagulation with weight based dose adjusted unfractionated Heparin. Numerous case reports and a single non randomized trial have shown that it is comparatively safe and may rescue patients who are deteriorating despite anticoagulation with unfractionated Heparin. Consideration must be given to the use of thrombolysis in this group. This is an approach that must be restricted to centers with considerable experience in neurointerventional therapy.

Cerebral Veins↗
PubMed1997

[Gradenigo syndrome and cavernous sinus thrombosis in fusobacterial acute otitis media].

In this era of antimicrobial medication, intracranial complications following otitis media are rare. We present a 5-year-old boy who suffered from petrositis (Gradenigo syndrome) and cavernous sinus thrombosis as combined complications of acute otitis media caused by fusobacteria. The diagnosis was made using imaging methods suited to the various structures of the skull. Cure was achieved by prolonged conservative treatment with antibiotics, with gallium scan for evaluation of the bone inflammation.

Cavernous Sinus↗
PubMed1996

Congenital cholesteatoma with spontaneous epidural abscess, sinus thrombosis and cutaneous fistula.

A congenital cholesteatoma or epidermoid is a benign mass that causes devastating effects if left untreated. An unusual case with a congenital cholesteatoma located in the mastoid region complicated by epidural abscess, sinus thrombosis, and cutaneous fistula is presented. The patient had normal otologic findings and had no neurologic deficit. A review of the literature found no report of a similar case.

Abscess↗
PubMed1986

Superior sagittal sinus thrombosis: assessment with Tc-99m labeled red blood cells.

The diagnostic value of scintigraphy with technetium-99m labeled red blood cells (Tc-RBC) was assessed in 19 patients with clinical suggestion of superior sagittal sinus thrombosis (SSST). Comparison of Tc-RBC static images with dynamic flow studies in the brain showed a sensitivity of 100%, specificity of 86%, and accuracy of 94% for static studies and values of 87%, 20%, and 61%, respectively, for the flow studies. Tc-RBC scintigraphy enables direct visualization of the integrity of the superior sagittal sinus, whereas CT scanning shows various but nonspecific changes in the brain associated with SSST. Single-photon emission CT study using Tc-RBC, performed in six patients, appears to have potential in the diagnosis of SSST, allowing separation of vascular structures that are superimposed on the superior sagittal sinus in planar scintigraphy study.

Adolescent↗
PubMed1999

Severe cerebral venous sinus thrombosis and dural arteriovenous fistula in an infant with protein S deficiency.

A 12-month-old infant presented with cerebral seizures and neurological deficits. MRI scan of the brain and angiography showed massive cerebral venous sinus thrombosis complicated by a dural arteriovenous fistula. Subsequent clotting analysis revealed a protein S deficiency. Screening for inherited coagulation inhibitor deficiency is recommended in children with unexplained or atypical thrombotic events.

Arteriovenous Fistula↗
PubMed1999

Superior sagittal sinus thrombosis occurring at high altitude associated with protein C deficiency.

A 42-year-old male presented with right-sided weakness, dysphasia and seizures while climbing the French Alps at an approximate altitude of 3,000 m. Imaging studies were consistent with superior sagittal sinus thrombosis with hemorrhage. Laboratory testing for thrombophilic states, 18 days after presentation at our hospital, showed a low protein C level (0.32 U/ml, normal 0.80-1.60 U/ml). A family member was also found to have protein C deficiency without a history of thrombosis. The patient gradually improved and was discharged on warfarin and valproic acid. This is the first reported case of cerebral venous thrombosis in a patient with congenital protein C deficiency who ascended to high altitude. We postulate that the ascent to high altitude represented an additional prothrombotic risk factor to the congenital protein C deficiency leading to cerebral thrombosis.

Adult↗
PubMed1998

Transverse sinus thrombosis and venous infarction of the brain following unilateral radical neck dissection.

Radical neck dissection is one of the commonest procedures performed in any unit dealing with head and neck surgery. Intracranial complications following this procedure are uncommon. Transverse sinus thrombosis and venous infarction of the brain following unilateral radical neck dissection have not been reported in the literature. We present a case in which this complication occurred following an uneventful radical neck dissection.

Aged↗
PubMed2002

Pseudotumor syndrome associated with antiphospholipid antibodies and cerebral venous sinus thrombosis.

Antiphospholipid antibodies have been recognized as a marker for an increased risk of thrombosis, including cerebral venous thrombosis. This is a clinical study of three patients who presented with features of raised intracranial tension. Investigations revealed normal CT of brain and CSF examination in two patients. MRI of brain revealed dural venous sinus thrombosis in all the patients and positive antiphospholipid antibodies in the blood. All patients recovered with anticoagulant therapy. Antiphospholipid antibodies should be considered in the differential diagnosis of pseudotumor syndrome related to cerebral venous thrombosis.

Adolescent↗
PubMed1994

Concurrent cerebral venous sinus thrombosis and myeloradiculopathy in Sjögren's syndrome.

A 41-year-old woman complained of severe headaches and developed quadriparesis and neurogenic bladder. Evaluation disclosed the presence of Sjögren's syndrome complicated by myeloradiculopathy with MRI evidence of cervical cord involvement. Concurrent cerebral venous sinus thrombosis was also noted. Treatment with steroids and warfarin led to clinical improvement and resolution of MRI findings.

Adult↗
PubMed1997

[Cerebral sinus thrombosis: rapid test diagnosis by demonstration of increased plasma D-dimer levels (SimpliRED)].

PURPOSE: To perform an initial evaluation of the accuracy in detection of dural sinus and cerebral venous thrombosis using a bed-side test (SimpliRED). MATERIAL AND METHODS: Early diagnosis and treatment of cerebral sinus thrombosis are important. A screening test to decide which patients should undergo further diagnostics would be valuable due to the low incidence. Six patients with MR proven cerebral sinus thrombosis underwent bed-side testing. The SimpliRED kit provides a clearly visible agglutination of the patient's red blood cells in the presence of elevated levels of the crosslinked fibrin derivative (D-dimer) in the sample. RESULTS: The assay yielded a positive result in all six patients, even 56 days following the onset of clinical symptoms. CONCLUSION: The sensitivity of SimpliRED in the detection of sinus venous thrombosis is not known. This assay, therefore, should be evaluated in a large prospective study. In addition, the capability of the test to assess the effect of and predict the duration of anticoagulation therapy should be considered.

Adolescent↗
PubMed2003

Thromboembolism after ovarian stimulation: successful management of a woman with superior sagittal sinus thrombosis after IVF and embryo transfer: case report.

The current literature was reviewed in order to analyse the clinical manifestations, progression and management, and pregnancy outcome of thromboembolism in infertile patients undergoing ovarian stimulation. The first case of superior sagittal sinus thrombosis following IVF that was successfully managed with intracranial thrombectomy is also reported. This retrospective cohort study comprised 65 women who experienced thromboembolism after ovarian stimulation (64 from other published studies and the present case report). Thrombosis attack occurred at a mean (+/-SD) of 25.5 +/- 20.1 days after oocyte retrieval. The onset timing in the intracranial thrombosis group (10.2 +/- 4.6 days) was less (P < 0.05) than in those experiencing thromboembolism at other sites. Ovarian hyperstimulation syndrome (OHSS), haemoconcentration and high serum estradiol level were noted in 79, 62 and 54% of women respectively. Forty-eight of 55 patients (87%) who received anticoagulation recovered without sequelae. Among patients willing to continue pregnancy, 32% succeeded in term delivery with all healthy babies, and 23% were ongoing pregnancies. In conclusion, ovarian stimulation cycles accompanying high serum estradiol levels, haemoconcentration or OHSS are at potential risk of thromboembolism. Dose-adjusted heparinization is recommended as the first-line treatment of choice, while intravascular thrombolysis or operative thrombectomy is an aggressive but effective treatment. Continuation of pregnancy is considered safe, without any increased risk of fetal congenital anomalies.

Adult↗