Prenatal diagnosis of thrombosis of the dural sinuses

Abstract

Thrombosis of the cerebral venous vessels is a rare event in the neonatal period, and prenatal detection of dural sinus thrombosis is even rarer. A 19-year-old woman with an uncomplicated pregnancy was referred at 22 weeks for a routine midtrimester ultrasonographic scan. The transabdominal scan revealed a triangular sonolucent area in the occipital region containing a round echogenic mass (Fig. 1). The scan also showed that the posterior segment of the superior sagittal sinus was dilated, with interruption of the venous flowpresumably at the level of the torcula herophilicaused by a homogeneous, 15-mm mass with a welldefined contour and no identifiable vascular flow. This structure was compatible with a blood clot ( Fig. 2). No other fetal anomalies were detected. Magnetic resonance imaging confirmed the dilatation of the torcula, of the distal segment of the superior longitudinal sinus, and of the right lateral sinus. High-intensity signaling in the lumen of these vascular structures on T1-weighted images and lowintensity signaling on T2-weighted images suggested venous thrombosis.The parents were informed that fetal prognosis was uncertain, and they chose to let the pregnancy proceed. The results of serologic evaluations for ToRCH (Toxoplasma gondii, rubella virus, cytomegalovirus, Herpes simplex virus, and embryopathy) agents in the mother and thrombophilia in both parents were negative. Subsequent sonographic fetal monitoring showed normal brain development and stable thrombus dimensions. A cesarean section at 39 weeks delivered a healthy female infant weighing 3690 g with no evidence of polycythemia or anticoagulant deficiency (no evidence of antithrombin, protein C, protein S, or factor V Leiden mutations). Magnetic resonance imaging performed on the fourth day confirmed the prenatal findings. At 18 months, the results of neurological and behavior evaluations were normal and magnetic resonance imaging showed normal brain development.

Antenatal thrombosis of torcular herophili presenting with anemia, consumption coagulopathy and high-output cardiac failure in a preterm infant

“…The clinical progression and prognosis is variable per descriptions. [3][4][5] We report the first case of torcular herophili thrombosis in a preterm infant causing anemia, consumption coagulopathy and high-output cardiac failure. Despite the acuity, aggressive clinical management led to the survival of the infant with a normal neuro-developmental outcome.…”

Thrombosed Dural Sinus Malformation in a Fetus: A Case Report

“…Clinical data on these patients are summarized in Table 1. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] The clinical course of live birth cases with thrombosed DSM is variable, ranging from death and neurological complications to normal neural development. However, many patients have a favorable outcome, as indicated in Table 1.…”

Sonographic Evaluation of the Superior Sinus Sagittalis

“…A second case with a normal outcome was reported by Visentin et al in 2001 [3] . Clode et al reported a series of three cases of fetal venous thrombosis in 2005 [7] . Another prenatal diagnosis of dural sinus thrombosis was reported by Legendre et al [8] .…”