Background Cerebral venous thrombosis is a potentially devastating condition. Predisposing factors include hypercoagulable state, infection, pregnancy, oral contraceptive use and female sex. Symptoms may include headache, nausea, vomiting, and visual changes. Papilledema, focal neurologic deficits, strokes, and seizures may occur. Treatment consists of systemic anticoagulation and management of the underlying process. Acetazolamide and cerebrospinal fluid diversion are reserved for cases with refractory, severe intracranial hypertension. Recently, neurointerventional techniques have shown promise in the treatment of this condition.
Case report We report the case of a 47-year-old male who presented with seizures and intracerebral hemorrhage. CT angiography showed near-complete occlusion of the superior sagittal sinus and occlusion of both transverse sinuses. Anticoagulation was initiated, but he continued to have seizures and his level of consciousness deteriorated. He was therefore taken to angiography and mechanical thrombectomy of his sagittal sinus was performed with the Penumbra device (Penumbra Inc., Alameda, California, USA). Flow was markedly improved in the superior sagittal sinus, and he recovered well post-operatively. He was discharged home on antiepileptic medication with no neurologic deficits.
Conclusion Mechanical thrombectomy is a viable option for revascularization of the dural venous sinuses in the setting of cerebral venous thrombosis.
Competing interests L Hnenny: None. D Fiorella: Codman and Shurtleff, Covidien ev3, NFocus Medical, Cordis, Micrus Endovascular. M Kelly: None.
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