Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment. We deployed the Solitaire FR device (4×20 mm) in the anterior portion of the thrombosed SSS, and it was left for ten minutes before the retraction. Thus, we removed a small amount of thrombus. But the sinus remained occluded. We therefore performed the thrombectomy using the same methods using the Solitaire FR (6×20 mm). Thus, we were successful in removing larger clots. Our case highlights not only that the mechanical thrombectomy using the Solitaire FR is effective in achieving revascularization both rapidly and efficiently available, but also that it might be another option in patients with cerebral venous sinus thrombosis who concurrently had rapid clinical deterioration with devastating consequences.
Adult ; Hemorrhage ; Humans ; Infarction ; Sinus Thrombosis, Intracranial ; Superior Sagittal Sinus ; Thrombectomy ; Thrombosis

A 33-year-old male was admitted with severe headache lasting 3 days. He did not have a focal neurologic deficit, but had a high intracranial pressure of 512 mmH2O. Cerebral angiography revealed venous sinus thrombosis that mainly involved the superior sagittal and right transverse sinuses. His headache remained severe after intravenous heparin infusion, and so interventional procedures were performed. Mechanical aspiration with the Penumbra system(TM) and other interventional procedures reopened the outflow of the superior sagittal sinus and effectively ameliorated this patient's headache.
Adult ; Cerebral Angiography ; Headache ; Heparin ; Humans ; Intracranial Pressure ; Male ; Neurologic Manifestations ; Sagittal Sinus Thrombosis ; Sinus Thrombosis, Intracranial ; Suction ; Superior Sagittal Sinus ; Thrombectomy ; Thrombolytic Therapy ; Transverse Sinuses ; Venous Thrombosis

We report superior sagittal sinus thrombosis as a central nervous system presentation of Behcet's disease in a patient with peripheral vascular and enteric involvement. The main symptoms were headache and horizontal diplopia due to intracranial hypertension. T1-weighted MRI with gadolinium enhancement revealed a similar pattern of the "empty delta sign" that is usually seen on brain CT. A magnetic resonance venogram revealed filling defects resulting from the thrombosis. These features are helpful for the noninvasive diagnosis of sagittal sinus thrombosis.
Brain ; Central Nervous System ; Diplopia ; Gadolinium ; Headache ; Humans ; Intracranial Hypertension ; Magnetic Resonance Spectroscopy ; Sagittal Sinus Thrombosis ; Superior Sagittal Sinus ; Thrombosis

Cerebral Venous Sinus Thrombosis (CVST) in children is rare and its cause is multifactorial. The clinical manifestations of CVST vary and may cause long-term neurological sequelae and even death on rare occasion. In this case, a 15 year old boy presented with severe headache and vomiting for 1 day. Brain MRI with venography revealed multiple lesions of CVST in superior sagittal sinus and the left transverse sinus. Anticoagulation therapy was performed for 3 months, which led to the complete resolution in superior sagittal sinus and partial resolution in left transverse sinus.
Adolescent ; Brain ; Child ; Headache ; Humans ; Phlebography ; Sinus Thrombosis, Intracranial ; Superior Sagittal Sinus ; Vomiting

Cerebral Venous Sinus Thrombosis (CVST) in children is rare and its cause is multifactorial. The clinical manifestations of CVST vary and may cause long-term neurological sequelae and even death on rare occasion. In this case, a 15 year old boy presented with severe headache and vomiting for 1 day. Brain MRI with venography revealed multiple lesions of CVST in superior sagittal sinus and the left transverse sinus. Anticoagulation therapy was performed for 3 months, which led to the complete resolution in superior sagittal sinus and partial resolution in left transverse sinus.
Adolescent ; Brain ; Child ; Headache ; Humans ; Phlebography ; Sinus Thrombosis, Intracranial ; Superior Sagittal Sinus ; Vomiting

We present a case of extensive thrombosis in the jugular vein and sigmoid, transverse, superior sagittal sinuses with partial deep venous thrombosis. The patient had acute severe headache but had neither focal neurological deficit nor consciousness change. Emergency endovascular thrombolysis through transfemoral approach was performed with successful restoration of venous drainage. There was no hemorrhagic complication. Several days later, the patient had a focal seizure attack due to focal venous infarction despite of continuous systemic anticoagulation therapy.
Colon, Sigmoid ; Consciousness ; Drainage ; Emergencies ; Headache ; Humans ; Infarction ; Jugular Veins ; Seizures ; Sinus Thrombosis, Intracranial ; Superior Sagittal Sinus ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Venous Thrombosis

Thrombosis of venous channels in the brain is not a common cause of cerebral infarction relative to arterial disease but is an important consideration because of its variable clinical features and potential morbidity. It is very often unrecognized at initial presentation. The diagnostic modality is brain imaging with magnetic resonance venography. An empty-delta sign appears on a contrast CT scan as enhancement of the collateral vein in the superior sagittal sinus wall surrounding a nonenhanced thrombus in the sinus. However, the sign is frequently absent. Heparin should be considered in the management of cerebral venous sinus thrombosis (CVST). We report a case of CVST in a 59-year-old woman that presented initially as a headache and was diagnosed after several visits to clinics.
Brain ; Cerebral Infarction ; Female ; Headache ; Heparin ; Humans ; Middle Aged ; Neuroimaging ; Phlebography ; Sinus Thrombosis, Intracranial* ; Superior Sagittal Sinus ; Thrombosis ; Tomography, X-Ray Computed ; Veins

We experienced a case of giant arachnoid granulation misdiagnosed as dural sinus thrombosis. A 66-year-old woman presented with a one month history of progressive occipital headache. Computed tomography angiography and cerebral angiography showed a round filling defect at the transverse sinus which was speculated as a transverse sinus thrombosis. Anticoagulation therapy was performed to prevent worsening of thrombosis for 2 weeks and then a Gadolinium-enhanced magnetic resonance imaging scan was performed. The filling defect lesion at the transverse sinus revealed a non-enhancing granule with central linear enhancement, which was compatible with giant arachnoid granulation. We checked the intrasinus pressure difference across the lesion the through the dural sinus in order to exclude the lesion as the cause of headache. Normal venous pressure with no significant differential pressure across the lesion was noted. Headache was treated with medical therapy.
Aged ; Angiography ; Arachnoid ; Cerebral Angiography ; Female ; Headache ; Humans ; Lateral Sinus Thrombosis ; Magnetic Resonance Imaging ; Sinus Thrombosis, Intracranial ; Thrombosis ; Venous Pressure

OBJECTIVE: Although it is well known that cerebral sinus thrombosis or resection of large cerebral veins during surgery may cause venous hypertension, often leading to brain edema and intracerebral hemorrhage and the outcome is widely variable with symptoms from headache to coma, the pathophysiology of cerebral venous circulatory disturbance is poorly understood. The purpose of this study was to investigate the pathophysiological change of cerebral venous circulatory disturbance by measurement of intracranial pressure, regional cerebral blood flow and cerebral water content, and histological examination for extravasation of Evans blue dye and cerebral edema for 2 hours after occlusion of the superior sagittal sinus and diploic veins in cats. METHODS: Thirty five cats were divided into 4 groups: (1) control group, 5 cats with sham operation, (2) experiment group I, 10 cats with occlusion at the anterior 1/3 of the superior sagittal sinus, (3) experiment group II, 10 cats with occlusion at the middle 1/3 of the superior sagittal sinus, (4) experiment group III, 10 cats with occlusion at the posterior 1/3 of the superior sagittal sinus. RESULTS: The results were as follows: 1) After occlusion of the superior sagittal sinus, intracranial pressure was elevated with increased cerebral water content and regional cerebral blood flow was reduced in all experiment groups. The degree of their changes was the least in experiment group I, the most in experiment group III, and intermediate in experiment group II. 2) Extravasation of the Evans blue dye was not observed in any experiment groups 120 minutes after occlusion of the superior sagittal sinus. 3) On the histological examination, pericellular edematous change of the brain was observed in all experiment groups 120 minutes after occlusion of the superior sagittal sinus. The degree of edema also showed similar pattern in magnitude to that of changes of other parameters. CONCLUSION: These results suggest that occlusion of the middle or posterior 1/3 of the superior sagittal sinus could bring a significant harmful effect to the cerebral hemodynamics, leading to secondary brain injury and the hydrostatic edema is responsible for the cerebral swelling in early stage after occlusion of the superior sagittal sinus.
Animals ; Brain ; Brain Edema ; Brain Injuries ; Cats ; Cerebral Hemorrhage ; Cerebral Veins ; Coma ; Edema ; Evans Blue ; Headache ; Hemodynamics ; Hypertension ; Intracranial Pressure ; Sinus Thrombosis, Intracranial ; Superior Sagittal Sinus ; Veins

OBJECTIVE: Although it is well known that cerebral sinus thrombosis or resection of large cerebral veins during surgery may cause venous hypertension, often leading to brain edema and intracerebral hemorrhage and the outcome is widely variable with symptoms from headache to coma, the pathophysiology of cerebral venous circulatory disturbance is poorly understood. The purpose of this study was to investigate the pathophysiological change of cerebral venous circulatory disturbance by measurement of intracranial pressure, regional cerebral blood flow and cerebral water content, and histological examination for extravasation of Evans blue dye and cerebral edema for 2 hours after occlusion of the superior sagittal sinus and diploic veins in cats. METHODS: Thirty five cats were divided into 4 groups: (1) control group, 5 cats with sham operation, (2) experiment group I, 10 cats with occlusion at the anterior 1/3 of the superior sagittal sinus, (3) experiment group II, 10 cats with occlusion at the middle 1/3 of the superior sagittal sinus, (4) experiment group III, 10 cats with occlusion at the posterior 1/3 of the superior sagittal sinus. RESULTS: The results were as follows: 1) After occlusion of the superior sagittal sinus, intracranial pressure was elevated with increased cerebral water content and regional cerebral blood flow was reduced in all experiment groups. The degree of their changes was the least in experiment group I, the most in experiment group III, and intermediate in experiment group II. 2) Extravasation of the Evans blue dye was not observed in any experiment groups 120 minutes after occlusion of the superior sagittal sinus. 3) On the histological examination, pericellular edematous change of the brain was observed in all experiment groups 120 minutes after occlusion of the superior sagittal sinus. The degree of edema also showed similar pattern in magnitude to that of changes of other parameters. CONCLUSION: These results suggest that occlusion of the middle or posterior 1/3 of the superior sagittal sinus could bring a significant harmful effect to the cerebral hemodynamics, leading to secondary brain injury and the hydrostatic edema is responsible for the cerebral swelling in early stage after occlusion of the superior sagittal sinus.
Animals ; Brain ; Brain Edema ; Brain Injuries ; Cats ; Cerebral Hemorrhage ; Cerebral Veins ; Coma ; Edema ; Evans Blue ; Headache ; Hemodynamics ; Hypertension ; Intracranial Pressure ; Sinus Thrombosis, Intracranial ; Superior Sagittal Sinus ; Veins