Isolated straight sinus and deep cerebral venous thrombosis: successful treatment with local infusion of urokinase

Case report

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✓ A 23-year-old woman presented with headache and progressive lethargy. The diagnosis of isolated thrombosis of the straight sinus and of the deep cerebral venous system was established using cranial computerized tomography, magnetic resonance imaging, phase-contrast magnetic resonance venography, and cerebral angiography. Because of the rapid deterioration in the patient's clinical condition, the authors used direct transcatheter infusion of urokinase into the straight sinus. This treatment resulted in a successful outcome.

Article Information

Address reprint requests to: D. Antonio Bell, M.D., Department of Radiology, Section of Neuroradiology, Bowman Gray School of Medicine, Medical Center Boulevard, Winston—Salem, North Carolina 27157–1088.

© AANS, except where prohibited by US copyright law.

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Figures

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    Left: Noncontrast-enhanced CT scan showing decreased attenuation in the thalami and basal ganglia, which is consistent with edema (open arrows). Hyperdensity in the internal cerebral veins (small arrows), the vein of Galen (not shown), and the straight sinus (arrowhead) suggests thrombosis. Right: Axial T2-weighted spin-echo MR image displaying abnormal increased signal intensity in the thalami and basal ganglia bilaterally (arrowheads), which represents edema.

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    Phase-contrast MR venogram (lateral projection) showing that flow is present in the superior sagittal sinus (arrows) and major arteries, but no flow is identified in the straight sinus or deep venous system.

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    Digital subtraction arteriograms (DSAs). Left: Oblique DSA (venous phase, arch injection) showing patency of the superior sagittal sinus, transverse sinuses, and sigmoid sinuses. The deep cerebral veins, inferior sagittal sinus, and straight sinus do not opacify. Center: A DSA (lateral projection) showing the microcatheter (arrow) advanced into the straight sinus. Contrast injection via the microcatheter demonstrates extensive filling defects caused by thrombus (arrowheads). A ventriculostomy catheter is present (open arrow). Right: A DSA (lateral projection) obtained after approximately 20 hours of urokinase infusion. The microcatheter (arrow) has been advanced. The straight sinus is now patent, although a small amount of residual thrombus persists.

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    Left: A digital subtraction arteriogram (DSA) (lateral projection, right internal carotid artery injection, late venous phase) showing persistent opacification of the right thalamostriate (large arrow), septal (small arrow), and internal cerebral (small arrowhead) veins, as well as the inferior sagittal sinus (open arrows) and a portion of the vein of Galen (large arrowhead). Right: A DSA (lateral projection, right internal carotid artery injection, venous phase) showing drainage of the right-sided deep cerebral venous system into the vein of Galen and the straight sinus (arrows).

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    Axial T2-weighted fast spin-echo MR image, obtained at 6-month follow-up examination, showing normal signal within the basal ganglia and thalami.

References

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