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 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.

    About the Lecture

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

    Included Quiz Questions

    1. MRI/MRV
    2. CT with contrast
    3. Lumbar puncture
    4. Non-contrast CT
    5. Ultrasound
    1. Anticoagulation
    2. Triptan medication
    3. Calcium channel blockers
    4. tPA
    5. Aspirin

    Author of lecture Acute Headaches: Venous Sinus Thrombosis

     Carlo Raj, MD

    Carlo Raj, MD

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