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.
The lecture Acute Headaches: Venous Sinus Thrombosis by Carlo Raj, MD is from the course Headache.
A 32-year-old obese woman presents to your office with a headache. She is 8 weeks postpartum and her pregnancy was uneventful that resulted in a term birth of a healthy male infant. She describes the pain as dull in nature and diffusely located over her skull. She also complains of visual disturbance. A fundoscopic examination reveals papilledema. A magnetic resonance venogram (MRV) shows an absent left transverse sinus. Which of the following is the most likely risk factor for this patient's condition?
A 45-year-old Caucasian male presents to the urgent care with a severe headache. He states that the pain started suddenly a few days ago but "wouldn't just go away." His medical history includes COPD, obesity, and deep venous thrombosis in his left leg. He is currently unemployed, noncompliant with his medications, and smokes 2-3 packs of cigarettes everyday. A physical examination would most likely reveal which of the following?
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