Continuing the discussion of acute
headache, we have venous sinus thrombosis.
Headache with abrupt
onset that lingers.
Diffuse, but occasionally
localized near vertex.
In other words, sagittal sinus,
and centro-parietal areas,
the transverse sinuses.
Please make sure that you’re familiar with
the two sinuses that might be affected
with venous sinus thrombosis.
Allow the name to speak to
you, transverse and sagittal.
Papilledema is going to be prominent.
More common during pregnancy
and immediate post-partum.
Once again, when you think of thrombosis,
you should be thinking estrogen,
Others in terms of possible etiologies,
ENT infection also
In other words, look at the name,
topic is venous sinus thrombosis
resulting in acute headache.
The name of the game is,
what causes thrombosis in these sinuses,
sagittal sinus, transverse sinus?
Diagnosis: MRI imaging.
Begin IV heparin followed
by oral anticoagulation.
In other words, well, depending on
the etiology, be careful though.
If venous strokes occur,
with local administration of
fibrinolytics may be needed
so that you can properly
identify and manage
your patient with venous
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.
Then as what this picture
is showing, specifically,
absent right transverse sinus.
Because every thrombosis is
blocking the proper circulation.
Summary of your venous
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.
Signs and symptoms: This is important
here, bilateral dull headache,
maybe perhaps a visual disturbance.
Remember, papilledema because this
is a venous sinus thrombosis.
Differential: In this female, perhaps,
pregnant lady, reproductive age;
Pseudotumor cerebri, you’ll
also find papilledema.
on image, pseudo means what?
So there’s no tumor, no
evidence of a tumor.
Diagnostic workup: Angiogram, MRI.
Treatment: anticoagulation, heparin;
in the hospital setting, warfarin.
In other words, anticoagulation.