William Hu, Mark Hudon
Sagittal Sinus Thrombosis
by: Jean-Wen Chan, William Hu, David Patry and Mark Hudon
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.
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
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
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
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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
Reprint requests to: Jean-Wen Chan, Dept of Radiology,
Foothills Hospital, 1403 - 29th Street NW, Calgary AB
T2N 2T9, Canada
J. Neurol. Sci. 2001; 28: 346-348