Superior sagittal sinus thrombosis as unusual cause of headache: case report

Tessitore, Enrico; Schonauer, Claudio; Fera, Francesco Saverio; Tessitore, Alessandro

doi:10.1007/s101940170035

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…3) should be considered when dealing with young women using hormone therapy [19]. Venous thrombosis can be identified by means of MRI and MRA or by CT angiography.…”

Section: Headache Attributed To Cranial or Cervical Vascular Disordersmentioning

confidence: 99%

Neuroradiology and headaches

2006

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Headache is one of the most common outpatient pain conditions encountered in both physician offices and emergency departments. Establishment of an accurate diagnosis, accomplished only by a thorough history followed by a physical examination, is critical before treatment can be initiated. Many patients undergo evaluation with computed tomography and more recently magnetic resonance imaging to exclude important abnormalities. It is known that a little percentage of patients showed significant neuroradiologiacal abnormalities and the rate of significant intracranial abnormalities in patients with headache and normal neurological examination exists.

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“…3) should be considered when dealing with young women using hormone therapy [19]. Venous thrombosis can be identified by means of MRI and MRA or by CT angiography.…”

Section: Headache Attributed To Cranial or Cervical Vascular Disordersmentioning

confidence: 99%

Neuroradiology and headaches

2006

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Neuroimaging and clinical neurophysiology in cluster headache and trigeminal autonomic cephalalgias

Friberg

Sandrini²,

Perrotta

2010

Handbook of Clinical Neurology

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Cerebral venous sinus thrombosis: a diagnosis not to be missed

Imtiaz

Rajpara²,

Majeed³

2010

Br J Hosp Med

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A 47-year-old woman was admitted with a severe headache of 5 days' duration, vomiting and collapse with transient loss of consciousness in December 2002. She had been taking black cohosh, a herbal preparation containing plant oestrogen for menopausal symptoms, for 2 years. Her father had a history of pulmonary embolism and her sister had systemic lupus erythematosus. Clinical examination was normal except for slight neck stiffness and photophobia. Brain computed tomography was normal and lumbar puncture revealed normal CSF; CSF pressure was not recorded. Her symptoms improved slowly and she was discharged home with an appointment with the neurologist arranged as an outpatient. Five days post-discharge from the hospital, she was readmitted because of the persisting headache and was found to have papilloedema on neurological examination. Chest X-ray, full blood count, erythrocyte sedimentation rate, clotting screen, urea and electrolytes, liver function tests, serum glucose, immunoglobulins, complement and autoantibody screening were normal or negative. Magnetic resonance imaging and venogram showed deep venous thrombosis in the superior sagittal sinus (Figure 1). She was anticoagulated with heparin followed by warfarin. Her headaches settled and she was discharged home 8 days later. Further investigations confirmed heterozygosity for the prothrombin gene variant (G20210A). She continued to describe ‘pressure headaches’ with tinnitus. Repeat brain magnetic resonance imaging and venogram was normal in 2004. Her headaches recurred and the diagnosis of secondary intracranial hypertension was made and acetazolamide and bendrofluazide were commenced. Further magnetic resonance imaging of the brain with venogram in September 2007 revealed a hypoplastic left transverse sinus and patent superior sagittal sinus. She was referred to the neurosurgeons and had a lumbo-thecal peritoneal shunt insertion in November 2007 with improvement in her symptoms, despite a small frontal subdural collection on brain computed tomography postoperatively, which had resolved on repeat magnetic resonance imaging in March 2008. She is regularly followed up in the neurology and ophthalmology clinics for residual bilateral papilloedema and left amblyopia and continues on ramipril, bendrofluazide and warfarin.

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Superior sagittal sinus thrombosis as unusual cause of headache: case report

Cited by 3 publications

References 13 publications

Neuroradiology and headaches

Neuroradiology and headaches

Neuroimaging and clinical neurophysiology in cluster headache and trigeminal autonomic cephalalgias

Cerebral venous sinus thrombosis: a diagnosis not to be missed

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