Dural Venous Sinus Thrombosis: A Case Report

Dural Venous Sinus Thrombosis is the formation of blood clot within the cerebral sinus. It is very rare case with varying clinical presentation. It has non-specific signs and symptoms ranging from headache, papilledema, seizures, focal neurological deficits and mental state changes which is caused by genetic and acquired prothrombotic states, infections, inflammatory disease and trauma. Magnetic Resonance Imaging with Magnetic Resonance Venography is the specific imaging technique for the diagnosis. We have described a case of a patient who presented with headache over the temporal and occipital region and was disoriented. The Computed Tomography, Magnetic Resonance Imaging, Magnetic Resonance Venography report revealed presence of thrombus in the transverse and sigmoid sinus with hemorrhagic infarcts. He was then treated with anticoagulants Low Molecular Weight Heparin which was further substituted by Warfarin.

Dural venous sinus thrombosis: A rare complication of pulse corticosteroid therapy in pemphigus vulgaris

Systemic pulse corticosteroid therapy is used widely in the treatment of pemphigus vulgaris. Dural venous sinus thrombosis as a complication of pulse therapy has not been reported in the literature. A middle-aged female with pemphigus vulgaris was started on monthly pulse dexamethasone therapy with daily azathioprine as an adjuvant. After two pulse therapies, she developed throbbing headache, which on further evaluation was determined to be due to dural venous thrombosis. Other causes of dural venous thrombosis were excluded. Pulse therapy was stopped and other medications were started. The headache subsided within two weeks of stopping pulse therapy. Corticosteroids may play the role of a procoagulant in producing cerebral venous sinus thrombosis. Herein, we report a rare case of dural venous sinus thrombosis due to pulse steroid therapy in pemphigus vulgaris.

Dural venous sinus thrombosis after lumbar puncture in a patient with idiopathic intracranial hypertension

Introduction: Idiopathic intracranial hypertension (IIH) is one of the most common causes of papilloedema seen by ophthalmologists and neurologists. Patients with IIH routinely undergo lumbar puncture (LP) for diagnosis. Dural venous sinus thrombosis (DVST) is a rare complication of cerebrospinal fluid pressure (CSF)-lowering procedures such as lumbar puncture and epidural and may be an intracranial complication of IIH. Case Description: A 29-year-old obese woman was diagnosed with severe idiopathic intracranial hypertension (IIH) after she presented with new-onset headache, pulsatile tinnitus and blurred vision. Magnetic resonance imaging (MRI) and venography (MRV) were normal apart from signs of intracranial hypertension. Lumbar puncture (LP) revealed an opening pressure of 40 cm of water. Due to the severity of the papilloedema and vision loss, she was referred for a ventriculoperitoneal shunt and found to have venous sinus thrombosis involving the superior sagittal sinus on the pre-operative computed tomography (CT) head 5 days after the LP. CT venography (CTV) one day later and MRV 3 days later showed significant worsening as the thrombosis extended into the deep venous system. She was started on therapeutic heparin and her symptoms and vision improved and she did not develop any neurological complications. Conclusions: DVST should be considered in IIH patients who have worsening papilloedema or symptoms of intracranial hypertension. Repeat venous imaging can prevent devastating consequences such as venous infarcts of haemorrhage in these patients.