Cerebral Dural Venous Sinus Thrombosis Following Cardiac Pacemaker Implantation

Abstract

The development of reliable implantable artificial pacemakers has revolutionized the management of a variety of cardiac conduction disturbances and arrhythmias. The advent of the transvenous route of electrode insertion has allowed the use of these devices in patients who could not tolerate the operative morbidity of transthoracic implantation. However, the transvenous method of implantation is not without significant hazard and many major risks are well recognized. It is the purpose of this communication to report the occurrence of cerebral dural venous sinus thrombosis involving the right laternal and sagittal sinuses in association with implantation of a transvenous pacemaker via the right jugular vein. The complication has not been previously recognized. Patient Summary A 54-year-old trucking company clerk was first told of his slow heart rate in 1957. In September 1959 he experi-enced an episode of substernal pain following which an electrocardiogram was said to have demonstrated atrioventricular dissociation. In March 1960, again after a brief period of substernal discomfort, he was noted to have atrial fibrillation with a slow ventricular re¬ sponse. During an attempt at conversion to normal rhythm with quinidine sulfate a regular junctional bradycardia de¬ veloped which reverted to atrial fibril¬ lation on discontinuation of therapy with the drug. In December, roentgenography showed he had cardiomegaly, but enjoyed a good exercise tolerance. In 1963 he suffered transient hemiplegia on the left and an ECG at that time demonstrated atrial flutter with complete heart block resulting in a ventricular rate of 38 beats per min¬ ute. During the next two years complete heart block was found at a number of examinations, but he was able to con¬ tinue full-time employment until Octo¬ ber 1965 when he noted the appearance of progressive dyspnea with activity. In November he was given a diuretic orally which resulted in an overnight diuresis of 8 lb. A transient period of visual hallucinations and insomnia occurred immediately following diuresis and diuretics were withheld. Within one week edema and dyspnea had recurred. At no time during his illness had he experienced presyncopal symptoms or other manifestations of Adams-Stokes syncope.The patient had no history of hyper¬ tension or chest pain which was clearly related to effort. Ten years previously

Superior Sagittal Sinus Thrombosis After Radical Neck Dissection

“…'0 Other cases of thrombosis have been reported from transvenous pacemaker insertion and the intrajugular infusion of hyperosmolar solutions. 11,12 The incidence of aseptic cerebral venous thrombosis is unclear. An autopsy study found the incidence of venous thrombosis to be greater than 1%.…”