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Neuroimaging Highlight

Editors: William Hu, Mark Hudon

Superior Sagittal Sinus Thrombosis

Submitted by: Jean-Wen Chan, William Hu, David Patry and Mark Hudon

A 30-year-old female suffered minor head and neck trauma while tubing on a lake. Three days later she experienced an episode of transient expressive dysphasia later followed by a generalized seizure. Medications include oral contraceptives.

Computed tomography revealed no significant abnormalities. Magnetic resonance imaging (MRI) demonstrated subtle hyperintense cortical signal in the lateral anterior right frontal lobe on FLAIR images (Figure 1) which was much more obvious on diffusion-weighted imaging (DWI) with associated decreased apparent diffusion coefficient (ADC) (Figures 2a and 2b). Hyperintense T1 signal thrombus is seen in the location of the superior sagittal sinus (SSS) (Figure 3). MR venography (Figure 4) showed reduced flow in the anterior two thirds of the superior sagittal sinus which was confirmed with catheter angiography (Figure 5a and 5b). Follow-up MRI at about one month revealed resolution of the previous abnormalities (Figures 6a-d).

Dural sinus thrombosis is a rare condition that presents with nonspecific, highly variable clinical findings. At least four typical syndromes of presentation have been described: i) pseudotumor cerebri, ii) headache and focal neurologic deficit, iii) focal seizure and headache, and iv) headache, nausea, long-tract symptoms, and progressive decline in level of consciousness.1 Imaging is mandatory with CT, MRI with MRV and/or cerebral angiography to provide the diagnosis. Distinct stages of parenchymal changes may be seen depending on the severity of venous congestion. Subtle early changes may be best detected with DWI but unlike arterial ischemia, DWI changes suggesting cytotoxic edema can be reversible and do not predict subsequent venous infarction.2,3,4

There is potential for full recovery with early treatment. An extensive etiologic search is needed as there are numerous causes or predisposing factors (infectious, hematological, connective tissue disorders, metabolic, trauma, pregnancy, neoplastic and medication related). The mainstay of therapy is to treat the cause and symptoms as well as anticoagulation with intravenous heparin. Local thrombolysis can be performed if there is clot extension or clinical worsening despite treatment.5

References

1.

Villringer A, Einhaupl KM. Dural sinus and cerebral venous thrombosis. New Horiz 1997; 5(4): 332-341.

2.

Tsai FY, Wang AM, Matovich VB, et al. MR staging of acute dural sinus thrombosis: correlation with venous pressure measurements and implications for treatment and prognosis. AJNR 1995; 16(5): 1021-1029.

3.

Ducreux D, Oppenheim C, Vandamme X, et al. Diffusion-weighted imaging patterns of brain damage associated with cerebral venous thrombosis. AJNR Am J Neuro Radiol 2001; 22(2): 261-268.

4.

Keller E, Flacke S, Urbach H, Schild HH. Diffusion- and perfusion-weighted magnetic resonance imaging in deep cerebral venous thrombosis. Stroke 1999; 30(5): 1144-1146.

5.

Bousser MG. Cerebral venous thrombosis: diagnosis and management. J Neurol 2000; 246(4): 252-258


From the Dept of Radiology (J-WC, WH, MH), Dept of Neurology (DP), Foothills Hospital, Calgary AB, Canada.
Received September 6, 2001. Accepted in final form September 27, 2001.
Reprint requests to: Jean-Wen Chan, Dept of Radiology, Foothills Hospital, 1403 - 29th Street NW, Calgary AB T2N 2T9, Canada

Can. J. Neurol. Sci. 2001; 28: 346-348

 


 
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