Hydrocephalus due to superior sagittal sinus thrombosis

Abstract

The great variability of clinical appearance is one of the main features of superior sagittal sinus thrombosis. However, hydrocephalus associated with cerebral sinus thrombosis is rare. We report on a patient presented with thunderclap headache, accompanied by nausea, vomiting, and drowsiness. Lumbar puncture ruled out subarachnoid hemorrhage, whereas CT revealed marked hydrocephalus. In addition, magnetic resonance venography then confirmed the diagnosis of cerebral sinus thrombosis. It is a rare occurrence but clinically important, since it entails disastrous sequels if unrecognized, and hydrocephalus is treated in the usual fashion with ventricular drainage.

Obstructive Hydrocephalus from Venous Sinus Thrombosis

“…The authors proposed that decompression of the ventricular system predisposes to the development of parenchymal hemorrhage by creating a larger pressure gradient across intraparenchymal veins. Additionally, in the published case reports, clinical improvement seems to be more closely associated with recanalization of the venous sinuses, than ventricular drainage [4,6]. As a result, we made the decision to forgo EVD placement in favor of thrombolysis and systemic anticoagulation, with the knowledge that EVD placement remained an option if the patient did not respond.…”

“…Even in the absence of anticoagulation and thrombolysis, there may be a risk of hemorrhage during EVD placement in patients with CVST. Such a case has been reported [6]. The authors proposed that decompression of the ventricular system predisposes to the development of parenchymal hemorrhage by creating a larger pressure gradient across intraparenchymal veins.…”

“…Among the four previously described patients with CVST and hydrocephalus, three of the four had signs of venous sinus thrombosis on the initial head CT [4,5]. In one patient, the initial CT did not show any changes of CVST and diagnosis was delayed as a result [6]. Awareness that CVST can present with isolated hydrocephalus is critical to not missing this treatable condition.…”

“…This edema causes mass effect, compression, and obstruction of CSF flow [4]. The remaining case in the literature is unique in that there was not significant parenchymal edema [6]. This patient's hydrocephalus was presumed to be from decreased absorption of CSF at the SSS.…”

“…With treatment the long-term prognosis for most patients with CVST is good, though a small percentage die or are left with significant disability [2]. Hydrocephalus from CVST is rare, and this patient represents the fifth case published in the English language literature [4][5][6].…”