"Pseudo-Delta Sign" on Computed Tomography in an Extremely Acute Stage of Superior Sagittal Sinus Thrombosis—A Case Report

Sato, Shuzo; Murase, Hiroshi; Ota, Hidekazu; Tsukagoshi, Hiroshi; Shiozawa, Zenji

doi:10.1177/000331979004100511

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…It is also possible that a local inflammatory reaction occurs with dilatation of vessels in the sinus walls as suggested by the frequent contrast enhancement surrounding the clot, known as the ''empty delta sign''. 14 In conclusion, isolated headache can be the only clinical sign of CVT in the absence of intracranial hypertension, SAH, meningitis or intracerebral lesion. In such cases CVT mostly involves a lateral sinus, either alone or in association with other sinuses.…”

Section: Discussionmentioning

confidence: 90%

Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases

Cumurciuc

Crassard²,

Sarov³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

266

180

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Background: Headache is the most frequent symptom in cerebral venous thrombosis (CVT), and usually the first. However, it has rarely been reported as the only symptom of CVT. Objectives: To study the characteristics of patients in whom headache was the only presentation of CVT in the absence of intracranial hypertension, subarachnoid haemorrhage (SAH), meningitis, or other intracranial lesion. Methods: From a prospective study of 123 consecutive patients with CVT only those with isolated headache and normal brain computed tomography (CT) scan and cerebrospinal fluid (CSF) examination were included in the present study. All patients underwent an extensive systematic aetiological work-up and were given intravenous heparin followed by oral anticoagulants. A detailed description of the headache was obtained. Results: Headache was only sign of CVT in 17 patients. The lateral sinus was the most frequently involved sinus (n = 15). Onset of headache was progressive in 11, acute in 3, and thunderclap in 3 patients. Once established, the headache was continuous in 15, diffuse in four and unilateral in 13, usually ipsilateral to the occluded lateral sinus. No specific risk factor or cause was found. All had a favourable evolution. Conclusion: The pathogenesis of isolated headache in CVT in the absence of intracranial hypertension, SAH, meningitis or intracerebral lesion is unknown but may involve changes in the walls of the occluded sinus. Hence MRI/MRV should be used to look for signs of CVT in all patients with recent headache (progressive or thunderclap) even when the CT scan and CSF examination are normal.

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Section: Discussionmentioning

confidence: 90%

Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases

Cumurciuc

Crassard²,

Sarov³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

266

180

View full text Add to dashboard Cite

show abstract

“…In addition, it is possible to have contrast involvement around the clot, which is known as the 'empty delta sign' which is a dilatation of the vessels as a result of local inflammation of the sinuses. [4,5] Rarely, headache in CVST may not be associated with any clinical findings. However brain computed tomography (CT) scanning and/or cerebrospinal fluid (CSF) examination usually reveal the conditions such as SAH, intracerebral infarction or haemorrhage that can be the cause of headache of CVST.…”

Section: Introductionmentioning

confidence: 99%

Headache as the sole presenting symptom of cerebral venous sinuses thrombosis: Subgroup analysis of data from the VENOST study

Duman¹,

Çınar²,

Uludüz³

et al. 2020

Agri

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Headache is the most common complaint in cerebral venous sinus thrombosis (CVST) and it may sometimes be the only symptom in these patients. This retrospective and prospective study was an investigation of any differences in terms of clinical risk factors, radiological findings, or prognosis in patients with CVST who presented with isolated headache (IH) and cases with other concomitant findings (non-isolated headache [NIH]). Methods: A total of 1144 patients from a multicenter study of cerebral venous sinus thrombosis (VENOST study) were enrolled in this research. The demographic, biochemical, clinical, and radiological aspects of 287 IH cases and 857 NIH cases were compared. Results: There were twice as many women as men in the study group. In the IH group, when gender distribution was evaluated by age group, no statistically significant difference was found. The onset of headache was frequently subacute and chronic in the IH group, but an acute onset was more common in the NIH group. Other neurological findings were observed in 29% of the IH group during follow-up. A previous history of deep, cerebral, or other venous thromboembolism was less common in the IH group than in the NIH group. Transverse sinus involvement was greater in the IH group, whereas sagittal sinus involvement was greater in the NIH group. The presence of a plasminogen activator inhibitor (PAI) mutation was significantly greater in the IH group. Conclusion:IH and CVST should be kept in mind if a patient has subacute or chronic headache. PAI, which has an important role in thrombolytic events, may be a risk factor in CVST. Detailed hematological investigations should be considered. Additional studies are needed.

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Hydrocephalus due to superior sagittal sinus thrombosis

Weidauer

Marquardt

Seifert

et al. 2005

Acta Neurochir (Wien)

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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.

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"Pseudo-Delta Sign" on Computed Tomography in an Extremely Acute Stage of Superior Sagittal Sinus Thrombosis—A Case Report

Cited by 4 publications

References 15 publications

Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases

Headache as the only neurological sign of cerebral venous thrombosis: a series of 17 cases

Headache as the sole presenting symptom of cerebral venous sinuses thrombosis: Subgroup analysis of data from the VENOST study

Hydrocephalus due to superior sagittal sinus thrombosis

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