Venous sinus thrombosis

Venous sinus thrombosis can occur in any of the venous sinuses, but occur most commonly in the superior sagittal and lateral sinuses (70% of cases).  The other famous location for venous sinus thrombosis is the cavernous sinus. 

Aetiology may be aseptic or septic.

Aseptic venous sinus thrombosis is associated with
  • Haematological causes 
  • Post surgical causes 
  • Drugs
    • OCP
    • Androgens
    • Ecstasy
  • Pregnancy  - most commonly postpartum
  • Inflammatory conditions
  • Malignancies

Septic venous sinus thrombosis is associated with sinusitis, otitis media, bacterial meningitis and also facial/orbital/dental infections.

Presentation of venous sinus thrombosis includes:
  • headache
  • focal seizures
  • paresis
  • papilloedema
  • impairment of consciousness

Features suggestive of cavernous sinus thrombosis include
  • Headache
  • Ophthalmoplegia
  • Proptosis 
  • Eyelid swelling
  • Decreased visual acuity 
  • Chemosis

  • MR-V/CT-V - classically look for empty delta sign  - but this is only present in 20%. A CT head without contrast will only show signs of a venous sinus thrombosis in a third of cases.
  • LP – is not a recommended investigation but if performed may show raised opening pressure, raised protein, pleocytosis

Treatment is to treat cause and anticoagulation.

Complications  include PE and in the case of cavernous sinus thrombosis hypopituitarism.

The diagram below is a brief reminder of the anatomy of the cavernous sinus:
Last updated February 2015


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