l' ".'"` va" Fig. 1 Patient 1. Precontrast computed tomographic scans demonstrating areas of increased attenuation

Transcription

1

2 i 'sit'' -k tz#. / e, = r + -e l' ".'"` va" "t 'hua th ;] fteqhiv.r'" ' Fig. 1 Patient 1. Precontrast computed tomographic scans demonstrating areas of increased attenuation in the region of the superior sagittal, straight, and right transverse sinuses and the Galenic and internal cerebral veins. The attenuation value in these regions is Hounsfield units. Hemorrhagic venous infarcts are also present in the right temporal lobe. sexe Egggmekgg ts enaes.(isii glsl. s e ee ixiag ee, pt paubes "tws sgl es if ig i?f' x ig',c s?g igs vaknv ge' 'Z'; g ev a.?"di x tsee.,,.,li'g#magelasr llha".s'tlltlit/i'{eeffg'//$s,ste}g:;s gs Fig. 3 Patient 1. Transectional view of the superior sagittal sinus, demonstrating an anternortem thrombus. Fig. 2 Patient 1. View of the posterior fossa at autopsy. The right transverse and sigmoid sinuses, which have (hematoxylin and eosin 40) been peeled from the skull with forceps, are occluded by fresh thrombus. died on the third hospital day. sive hemorrhagic infarcts of the midbrain, both At autopsy, the brain was edematous and weighed 1,350 g. The cerebral surface was enti- thalami and the basal ganglia. Patient 2. rely covered with severe subarachnoid hemor- A 38-year-old woman was admitted to our faci- rhage. The superior sagittal, straight, bilateral lity with a 24-hour history of worsening headache transverse and sigmoid sinuses were occluded by and frequent vomiting. On admission, her consciousness was clear. There was neither neuro- fresh antemortem thrombi (Figs. 2 and 3). The left transverse and sigmoid sinuses were hypoplastic. logical deficit nor papilledema. She had no definite The internal cerebral and Galenic veins were also past history of otic disease. She had been taking thrombosed. On brain section there were exten- oral contraceptives for 10 months. Routine coagu- '

3 137 mu""6e k gxts ikll tw,estw 'k.s,i geec 'Ss A pt $ g' sik. S', ge,".k.,.a ss # deig:pt E#lybs' ff?g f, S' tsw'' sa er, sw tl ' "' iilill Fig. 4 Patient 2. Precontrast computed tomographic scans demonstrating areas of increased attenuation in the region of the left transverse and superior sagittal sinuses. The attenuation value of these regions is Hounsfield units. Fig. 5 Patient 2. Anteroposterior (A) and lateral (B) views of digital subtraction angiqgram demonstrating occlusion of the superior sagittal and left transverse sinuses. lation studies showed normal findings. Precontrast CT scans revealed areas of increased at- concurrent mastoiditis on the left side (Fig. 6). A diagnosis of dural sinus thrombosis was made and tenuation within the superior sagittal and left therapy with low molecular weight dextran and transverse sinuses, but neither parenchymal systemic fibrinolytic agent was initiated. Uro- lesions nor subarachnoid hemorrhage (Fig. 4). Digital subtraction angiography (DSA) demon- kinase was administered through continuous strated obstruction of the superior sagittal and In addition, an otologist was consulted for man- venous infusion (2 X 105 units/day) fpr five days. left transverse sinuses (Fig. 5). Magnetic reson- agement of the mastoiditis. Headache and vomit- ance (MR) imaging demonstrated hyperintense ing subsided within a week. She was discharged a areas in the superior sagittal and left transverse month later and had no neurological deficits. Follow-up MR imaging demonstrated recanaliza- sinuses on both Tl- and T2-weighted images with

4

5

6