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 includes MRI, and MRV.
Therefore, you can confirm the diagnosis with a venography.
03:02
Treatment: anticoagulation, heparin;
in the hospital setting, warfarin.
03:08
In other words, anticoagulation.