We report a case of a 42 year old nepali man diagnosed with cerebral venous sinus thrombosis after presenting with a week long history of. It is suspected to be a consequence of genetic predisposition and the hypercoagulable state occurring during disease relapse. A case report of cavernous sinus thrombosis after trauma. Cerebral venous sinus thrombosis postgraduate medical. Women tend to be at an increased risk particularly between the ages of 20 35, mainly due to the use of the oral contraceptive pill and the post partum state 1,3. It is also a rare occurrence along with the cerebral veins. In conjunction with anticoagulation, iv hydration is started to treat dehydration and reduce blood viscosity. Superior sagittal sinus thrombosis and pulmonary embolism. Cerebral venous sinus thrombosis cvst is a rare and potentially lifethreatening condition. Cerebral venous sinus thrombosis cvst is the presence of a blood clot in the dural venous. Cerebral venous sinus thrombosis cvt is a disease that is difficult to diagnose because of large variability of clinical symptoms and signs. A keyword search of imaging reports for the terms cerebral venous thrombosis and dural sinus thrombosis was used, and a total of 30 cases of cerebral venous thrombosis were identified, imaged by mr from 1999 to. Cerebral venous drainage is comprised of two systems, the superficial and the deep venous systems.
The clinical presentation can include headaches, papilledema, seizures, focal neurological deficits, and in the worst cases, can progress to coma, and death. Longterm outcome after cerebral venous thrombosis core. Sinus thrombosis, or venous sinus thrombosis, is a rare type of blood clot found within the dural venous sinuses. Cerebral venous sinus thrombosis can often present clinically in a very nonspecific manner, and easily missed without a strong clinical suspicion this case demonstrates sequentially on cross sectional imaging the appearances of dural sinus thrombosis along with an associated hemorrhagic venous infarction and its maturation. Partially recanalized chronic dural sinus thrombosis.
Broadly, the treatment of sagittal sinus thrombosis may be divided into two parts. Cerebral venous sinus sinovenous thrombosis csvt is an increasingly recognized cause of childhood and neonatal stroke. Cavernous sinus thrombosis is a blood clot in the cavernous sinuses. Cerebral venous sinus thrombosis cvst is an uncommon condition affecting 34 casesmillionyear with a mean age of 37 to 38, though any age may be affected 1,2. In the international study on cerebral vein and dural sinus thrombosis iscvt, the median age of patients with cvt was 37 years, and only 8 percent of the patients were older than 65. This is a rare disorder and can be of two typesseptic cavernous thrombosis and aseptic cavernous thrombosis. It has no age predilection and its presentation may be acute, subacute or chronic.
Cerebral venous sinus thrombosis cvst is a rare clinicopathological entity with substantial diagnostic and therapeutic dilemmas. In addition, the imaging findings are often subtle. Although clinical signs and symptoms are variable, headaches along with papilledema, dizziness and focal neurological deficits are commonly seen. Imaging techniques and pitfalls are reported and the therapeutic options are discussed. Superior sagittal sinus thrombosis presenting as a. Cavernous sinus thrombosis cst is a rare condition, usually results from a late complication of an infection of the paranasal sinuses. Symptoms may include headache, abnormal vision, any of the symptoms of stroke such as weakness of the face and limbs on one side of. Management of thrombosis of the dural sinus and cerebral veins cvt includes treatment of the underlying condition, antithrombotic treatment, symptomatic treatment, and the prevention or treatment of complications. Symptoms may include headache, abnormal vision, seizures, and any of the symptoms of stroke such as weakness of the face and limbs on one side of the body.
Acute treatment of cerebral venous and dural sinus thrombosis. Cerebral venous sinus thrombosis is a rare but dangerous condition, occurring with an incidence of 34 casesmillionyear. Cerebral venous sinus thrombosis cvst is a rare strokelike syndrome with significant morbidity and mortality. The sagittal sinus appeared to be the source of pulmonary emboli in previously reported cases.
The origin of aseptic cavernous sinus thrombosis is usually through trauma or a prothrombotic. Delay in diagnosis of cerebral venous and sinus thrombosis. A case report figure 1 head mri of the patient revealed thrombus of the superior sagittal sinus, extending from vertex level to just above the confluence of the sinuses. In comparison, deep venous thrombosis dvt of the lower extremity is approximately 250 times as common.
The purpose of this statement is to provide an overview of cerebral venous sinus thrombosis and to provide recommendations for its diagnosis, management, and treatment. The association between otogenic lateral sinus thrombosis and thrombophilia a longterm followup. Cavernous sinus thrombosis differentials bmj best practice. Septic sagittal sinus thrombosis septic sagittal sinus thrombosis is an uncommon condition that occurs as a consequence of purulent meningitis, infections of the ethmoid or maxillary sinuses spreading via venous channels, compound infected skull fractures, or, rarely, neurosurgical wound infections. The cavernous sinuses are hollow spaces located under the brain, behind each eye socket. Symptoms and signs include pain, proptosis, ophthalmoplegia, vision loss, papilledema, and fever. Magnetic resonance venography mrv confirmed the presence of a superior sagittal sinus thrombosis with a small venous infarct figure figure11 and the patient was subsequently anticoagulated with enoxaparin and warfarin. Sagittal sinus thrombosis thrombosis superior longitudinal sinus.
Cavernous sinus thrombosis eye disorders merck manuals. Cerebral venous sinus thrombosis in a preterm infant. Superior sagittal sinus thrombosis ssst is the most common type of dural venous sinus thrombosis and is potentially devastating. Efns guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Cerebral venous sinus thrombosis capecchi 2018 journal of. It is very often unrecognised at initial presentation. A comprehensive synopsis on cerebral venous thrombosis is presented. Cerebral venous sinus thrombosis signaled by bilateral.
Intravenous heparin or subcutaneous lowmolecularweight heparin should be used in acute cvt to prevent thrombus propagation and pulmonary. Increased suspicion for thrombosis is warranted in patients with temporal or skull base fractures. Cavernous sinus trombosis dr munish kumar g b pant delhi 2. What is the management of sagittal sinus thrombosis. The following are four cases of cerebral venoussinus thrombosis cvt who present initially as intracranial hemorrhage ich. Cerebral vein and cerebral venous sinus thromboses are blood clots that form in the veins that drain the blood from the brain called the sinuses and cerebral. Cavernous sinus thrombosis is a very rare, typically septic thrombosis of the cavernous sinus, usually caused by nasal furuncles or bacterial sinusitis. Cerebral venous sinus thrombosis cvst is the presence of a blood clot in the dural venous sinuses, which drain blood from the brain. A rare and uncommon medical condition cerebral venus sinus thrombosis cvst occurs when a blood clot forms in the brains venous sinuses that prevents blood from draining out of the brain. Cerebral sinus thrombosis has been reported as an uncommon complication of ulcerative colitis uc, occurring in up to 7. Treatment and management of venous sinus thrombosis sebastian pollandt, md. Cerebral venous and sinus thrombosis is a relatively rare condition with a variable presentation that can translate into a difficult workup and a delay in diagnosis and treatment. Treatment and management of venous sinus thrombosis. A cerebral venous sinus thrombosis cvst occurs when a blood clot forms in the dural venous sinuses, which drain blood from the brain.
Efns guideline on the treatment of cerebral venous and. Even in patients with no evidence of systemic thrombosis, but who have sagittal sinus thrombosis, the possibility of dislodging pulmonary emboli should be strongly considered. Diagnosis and management of cerebral venous thrombosis stroke. Extensive dural venous sinus thrombosis involving the entire superior sagittal sinus, right transverse and sigmoid sinuses partial thrombosis of the left transverse sigmoid sinuses and several parasagittal cortical veins. Cerebral venous sinus thrombosis presents a diagnostic challenge due to its varied presentation patterns. Cavernous sinus thrombosis is treated with highdose antibiotics given through a vein iv if an infection is the cause. Cerebral venous sinus thrombosis cvst is rare in the pediatric population.
Pdf cerebral sinovenous thrombosis csvt is a serious complication of lasparaginase chemotherapy for leukemia in children. Cerebrospinal fluid leakage and cerebral venous sinus. Superior sagittal sinus thrombosis radiology reference. Dural venous sinus thrombosis this involves the formation of clot on the superficial veins in the dura mater. Summary the cerebral venous system is an unusual site of thrombosis, with a particularly high incidence in young adults. A major blood vessel called the jugular vein carries blood. Cerebral vein and cerebral venous sinus thrombosis is an uncommon type of clot.
The efficacy and safety of lowmolecularweight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis. Cavernous sinus thrombosis cst was initially described by bright in 1831 as a complication of epidural and subdural infections. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Cerebral venous sinus sinovenous thrombosis in children. Although most commonly caused by sinusitis, cst has also been documented to arise from facial cellulitis, and several cases of cst due to nasal dorsum foci of infection have been. Recent developments in the field highlight the expanding spectrum of perinatal brain injury associated with neonatal csvt. Cerebrospinal fluid leakage and cerebral venous sinus thrombosis. Superior sagittal sinus thrombosis ssst is associated with a host of predisposing factors, including pregnancy, collagen vascular disease, malignancy, diabetes insipidus, and medications such as oral contraceptive agents, lasparaginase, androgens, and heparin. Radiologic diagnosis of cerebral venous thrombosis.
Infection can spread to the cavernous sinus either as an extension of thrombophlebitis or by septic emboli. Cortical venous sinus thrombosis the thrombosis is located on the cortical. Five months ago my 17 yo daughter woke up with a headache which after ct scans, mris, mras and an angiogram of the brain she was diagnosed with sagittal sinus thrombosis. Cerebral vein and cerebral venous sinus thrombosis university of. Diagnosis and treatment of cerebral venous thrombosis.
There was no family history of migraine or other headache disorder. The condition is often difficult to diagnose because symptoms vary from person to person depending on the location of the clot. Venous sinus thrombosis can be an overlooked sequel to head injury. Other causes include prothrombotic disorders, anemia and. Blood thinners help dissolve the blood clot and prevent it from getting worse or recurring. Cavernous sinus anatomy large venous space situated in the middle cranial fossa, on either side of body of the sphenoid bone. This usually develops as a sharp pain located behind or around the eyes that steadily gets worse over time. Large sinuses such as the superior sagittal sinus are most frequently involved. Intracranial hemorrhage as initial presentation of cerebral venous. This article focuses on the specific features related to the superior sagittal sinus thrombosis, please refer to the d ural venous sinus thrombosis article for a general discussion. Following treating a case of superior sagittal sinus thrombosis, we did an extensive search of the literature, eliciting 795 cases of the disorder. The dural sinuses are grouped into the sagittal, lateral including the transverse, sigmoid, and petrosal sinuses, and cavernous sinuses. Pdf posttraumatic superior sagittal sinus thrombosis.
We report a case of a 23yearold male patient with oneyear history of uc. We describe the successful use of mechanical thrombectomy and thrombolysis in the case of an eighteenyearold woman that presented with progressive thrombosis of the jugular veins and dural sinuses. Extensive collateral circulation within the cerebral venous system allows for a. Overview 6% of all intracranial complications of csom in csom direcrt spread through bone erosion and thrombophlebitic spread through emissary veins. Backgroundthe purpose of this statement is to provide an overview of cerebral venous sinus thrombosis and to provide recommendations for. Surgery is sometimes needed to drain the infection. Significance of seizure in cerebral venous sinus thrombosis. It emphasizes the various aetiologies, the wide clinical spectrum and the unpredictable outcome. Thrombus formation within the cavernous sinus, which may be either septic or aseptic in origin. An analysis showed that even after the introduction of antibiotics, the preponderance of these cases have. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage. Objective cerebral venous thrombosis is often associated with nonspecific clinical complaints.
Diagnosis and management of cerebral venous thrombosis. Further investigations including echocardiography, carotid artery doppler. Cavernous sinus thrombosis cst is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. Cerebral venous thrombosis cvt, also called cerebral venous sinus thrombosis cvst, is a cerebrovascular disease with diverse clinical. Symptoms often start within a few days of developing an infection in the face or skull, such as sinusitis or a boil. Venous sinus thrombosis with venous hemorrhage radiology. Other treatment modalities include corticosteroids or. Cavernous sinus thrombosis is a rare but welldocumented complication of sinus disease, propagated by intracranial spread of infection via valveless veins of the midface. Compared with men, women were significantly younger median age 34. If the diagnosis is entertained, prompt performance of appropriate imaging studies should be instituted so that therapy can be. Sagittal sinus thrombosis is one of the possible presentations of a more general disorder called cerebral venous thrombosis. Cerebral sinus thrombosis free download as powerpoint presentation.
Every doctor who spoke to her made a point of telling her that her. Efns guideline on the treatment of cerebral venous and sinus thrombosis in adult patients k. Cerebral venous and sinus thrombosis cvst is a rare. The intended audience is physicians and other healthcare providers who are responsible for the diagnosis and management of patients with cerebral venous sinus thrombosis. The most common initial symptom of cavernous sinus thrombosis is a headache. Mary is a 30yearold female who presented with a 1week history of leftside neck pain and headaches that acutely increased in severity on the day of admission with associated nausea and vomiting. We also recorded recurrent venous thromboembolism vte and hemorrhagic events during followup and antithrombotic medication use. Seizures are the presenting feature of cerebral venous sinus thrombosis cvst in 1231.
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