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Acute Headaches: Venous Sinus Thrombosis

by Carlo Raj, MD
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    00:01 Continuing the discussion of acute headache, we have venous sinus thrombosis.

    00:05 Headache with abrupt onset that lingers.

    00:09 Diffuse, but occasionally localized near vertex.

    00:13 In other words, sagittal sinus, and centro-parietal areas, the transverse sinuses.

    00:19 Please make sure that you’re familiar with the two sinuses that might be affected with venous sinus thrombosis.

    00:26 Allow the name to speak to you, transverse and sagittal.

    00:31 Papilledema is going to be prominent.

    00:34 More common during pregnancy and immediate post-partum.

    00:37 Once again, when you think of thrombosis, you should be thinking estrogen, pregnancy, post-partum.

    00:44 Others in terms of possible etiologies, hypercoagulable states, ENT infection also may predispose.

    00:53 In other words, look at the name, topic is venous sinus thrombosis resulting in acute headache.

    00:59 The name of the game is, what causes thrombosis in these sinuses, sagittal sinus, transverse sinus? Diagnosis: MRI imaging.

    01:12 Begin IV heparin followed by oral anticoagulation.

    01:15 In other words, well, depending on the etiology, be careful though.

    01:19 If venous strokes occur, cerebral venography with local administration of fibrinolytics may be needed so that you can properly identify and manage your patient with venous sinus thrombosis.

    01:36 You’ll notice that on your venogram that, on imaging, and you don’t find any of your blood vessels that you normally should in this area.

    01:50 Then as what this picture is showing, specifically, absent right transverse sinus.

    01:56 Why? Because every thrombosis is blocking the proper circulation.

    02:05 Summary of your venous sinus thrombosis: Hypercoagulable states, pregnancy.

    02:12 For the most part, you’re thinking about estrogen, and we talked about how local infection may occur as well maybe after an ENT type of procedure.

    02:21 Preventive medicine: identify predisposition.

    02:24 Signs and symptoms: This is important here, bilateral dull headache, maybe perhaps a visual disturbance.

    02:29 Remember, papilledema because this is a venous sinus thrombosis.

    02:34 Differential: In this female, perhaps, pregnant lady, reproductive age; differential, pseudotumor cerebri, migraine.

    02:44 Pseudotumor cerebri, you’ll also find papilledema.

    02:47 However, on image, pseudo means what? False.

    02:51 So there’s no tumor, no evidence of a tumor.

    02:54 Diagnostic workup: Angiogram, MRI.

    02:58 Treatment: anticoagulation, heparin; in the hospital setting, warfarin.

    03:02 In other words, anticoagulation.


    About the Lecture

    The lecture Acute Headaches: Venous Sinus Thrombosis by Carlo Raj, MD is from the course Headache.


    Included Quiz Questions

    1. Multiple myeloma
    2. Use of antifibrinolytics
    3. Deep vein thrombosis
    4. Mitral valve vegetation
    5. Traveling on a long haul flight
    1. Papilledema
    2. Throbbing headache
    3. Ipsilateral hemiparesis
    4. Hearing disturbances
    5. Projectile vomiting

    Author of lecture Acute Headaches: Venous Sinus Thrombosis

     Carlo Raj, MD

    Carlo Raj, MD


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