A simple and successful treatment for rupture and defect of the posterior third superior sagittal sinus caused by open depressed skull fracture: A case report / 中华创伤杂志(英文版)

It is extremely dangerous to treat the posterior third of the superior sagittal sinus (PTSSS) surgically, since it is usually not completely ligated. In this report, the authors described the case of a 27-year-old man with a ruptured and defective PTSSS caused by an open depressed skull fracture, which was treated by ligation of the PTSSS and the patient achieved a positive recovery. The patient's occiput was hit by a height-limiting rod and was in a mild coma. A CT scan showed an open depressed skull fracture overlying the PTSSS and a diffuse brain swelling. He underwent emergency surgery. When the skull fragments were removed, a 4 cm segment of the superior sagittal sinus (SSS) and the adjacent dura mater were removed together with bone fragments. Haemorrhage occurred and blood pressure dropped. We completed the operation by ligating the severed ends of the fractured sagittal sinus. One month after the operation, apart from visual field defects, he recovered well. In our opinion, in primary hospitals, when patients with severely injured PTSSS cannot sustain a long-time and complicated operation, e.g., the bypass using venous graft, and face life-threatening conditions, ligation of the PTSSS is another option, which may unexpectedly achieve good results.

Internal acoustic opening: different osseous landmarks and their clinical implications / Poro acústico interno: diferentes hitos óseos y sus implicaciones clínicas

SUMMARY: Internal acoustic opening is a space that opens to facies posterior of the petrous piece of temporal bone that goes inside facial nerve, vestibulocochlear nerve, intermedial nevre and labyrinthine artery. The purpose of this study is the assessment of internal acoustic opening from a morphometric perspective, determination of the shape of the hole and determination of the distance to some important anatomic formations. This study is conducted on 166 temporal bones with unknown sex formation which are part of the skull collection in NEU and KTO Karatay University, Anatomy Department. In this study, the vertical and diameter of internal acoustic meatus, its distance to the bottom and top sides of posterior surface of the petrous part, its distance to groove for superior sagittal sinus and its distance to apex were measured. Moreover, in this study internal acoustic opening spaces are categorized into six groups as round, oval, U-shaped, fissure, irregular and V shape. Digital caliper was used for internal acoustic meatus measurements. While the vertical horizontal diameters and distance to groove for superior sagittal sinus of internal acoustic opening on the right side are 4.12 mm, 6.83 mm and 19.64mm respectively, they are 4.56 mm, 7.10 mm and 21.06 mm on the left side respectively. We have observed in this study, 37.3 % of the internal acoustic opening as round, 34.3 % as oval, 6.6 % as U-shaped, 6.6 % as fissure, 12.7 % as irregular and 2.4 % as V-shaped. We believe that these measurements can provide guidance and help in surgical procedures.

RESUMEN: El poro acústico interno es un espacio que se abre en la cara posterior de la parte petrosa del hueso temporal, donde entran los nervios facial, intermedio y vestibulococlear, además de la arteria laberíntica. El propósito de este estudio fue la evaluación del poro acústico interno desde una perspectiva morfométrica, determinación de la forma del foramen y de la distancia a algunas formaciones anatómicas importantes. Este estudio se realizó en 166 huesos temporales de individuos de sexo desconocido que forman parte de la colección de cráneos del Departamento de Anatomía en NEU y KTO, Universidad de Karatay, Se midió la altura vertical y el diámetro del poro acústico interno, su distancia a los lados inferior y superior de la superficie posterior de la parte petrosa, su distancia al surco del seno sagital superior y su distancia al vértice. Además, el poro acústico interno se clasificó en seis grupos: redondos, ovalados, en forma de U, de fisura, irregulares y en forma de V. Se utilizó un calibrador digital para las mediciones del meato acústico interno. Mientras que los diámetros horizontales, verticales y la distancia al surco para el seno sagital superior del poro acústico interno en el lado derecho fue de 4,12 mm, 6,83 mm y 19,64 mm respectivamente, en el lado izquiedo fue de 4,56 mm, 7,10 mm y 21,06 mm, respectivamente. Hemos observado que en el 37,3 % de los casos el poro acústico interno era redondo, el 34,3 % ovalado, el 6,6 % en forma de U, el 6,6 % de fisura, el 12,7 % irregular y el 2,4 % en forma de V. Estas medidas pueden servir de guía y ayuda en los procedimientos quirúrgicos.

Trombosis de senos venosos cerebrales una manifestación extrapulmonar de COVID-19: Reporte de caso / Cerebral venous sinus thrombosis, an extrapulmonary manifestation of COVID-19: A case report

Resumen La trombosis de senos venosos cerebrales es un evento infrecuente en la población pediátrica y sus manifestaciones clínicas pueden variar dependiendo de la localización y extensión de la lesión, etiología o grupo etario (1); así mismo, la asociación de esta patología con virus es poco común, sin embargo, se han repor tado casos de trombosis de senos venosos en pacientes adultos con SARS-CoV-2 en relación con los mecanismos de lesión endotelial y respuesta inflamatoria que desencadena mecanismos procoagulantes. A continuación se presenta el primer caso reportado en Colombia de un caso de trombosis venosa cerebral en un lactante previamente sano, que debuta con un cuadro infeccioso gastrointestinal que resuelve y una semana después se presenta con cefalea y paralisis del VI par craneal derecho. Se documentó por angioto mografía trombosis del seno venoso sagital con extensión a senos transversos; los laboratorios fueron negativos para otras causas sistémicas y con prueba de anticuerpos para coronavirus positiva.

Abstract Cerebral venous sinus thrombosis is infrequent in the pediatric population and its clinical manifestations may vary depending on the anatomical location and the extent of the lesion, etiology or age group(1). The association of this pathology with viruses is uncommon, however, cases in adults with SARS-Cov2 have been reported triggered by procoagulant mechanisms due to endothelial injury and inflammatory response. The following article is the first reported case in Colombia of cerebral venous thrombosis in a previously healthy child, who debuted with gastrointestinal infectious disease and a week later with headache and sixth right cranial nerve palsy . The diagnosis of sagittal venous sinus thrombosis with extension to transverse sinuses was documented in a computed tomography angiography; laboratories for systemic diseases were negative and antibodies for coronavirus were positive.

Analysis of Clinical Features, Risk Factors and Laboratory Parameters in Cerebral Venous Thrombosis: A Study of 70 Cases

Introduction: Cerebral venous thrombosis (CVT) has variableclinical presentations mimicking other neurological disorders.There is variation in risk factors for CVT in different areas.Study was done with the aim of analyzing the clinical features,risk factors and laboratory parameters on patients diagnosedwith CVT on Magnetic Resonance Venography (MRV) andMRI.Material and Methods: In this retrospective study, data of70 consecutive patients attending a private neurology centerwith CVT confirmed on MRV and MRI from May 2016 toApril 2019 was analyzed. Laboratory parameters emphasizedwere hemoglobin content, serum homocysteine level and lipidprofile.Results: Out of 70 patients, 48 were men and 22 women inthe age range of 14 to 71 years. Most common presentingsymptom was progressive headache (63 cases,90%) aloneor in combination with other symptoms like vomiting (22cases, 31.42%), hemiparesis (17 cases, 24.28%), ataxia(17 cases, 24.28%) and seizures (15 cases, 21.42%).Hyperhomocysteinemia was seen in 15 cases (21.42%),anemia in total 30 cases (42.85%), and alcoholism in sevencases (10%). Twenty four patients (34.28%) had high densitylipoprotein (HDL) level of less than 40mg/dl, five patients(7.14%) had total cholesterol more than 200mg/dl and threepatients (4.28%) had triglycerides more than 200mg/dl. Onepatient (1.42%) had protein S deficiency.Conclusion: CVT is an uncommon but treatable cause ofstroke in young patients. Due to variety of clinical presentation,a high degree of clinical suspicion is neccessory for correctdiagnosis and early treatment.

Superior Sagittal Sinus Invasion by Malignant Glioma: Case Report and Literature Review

Anaplastic oligodendrogliomas (AOs) correspond to 23% of all oligodendrogliomas. They correspond to a tumor with malignant histological characteristics, focal or diffuse, associated with a worse prognosis. In the present case report, we describe the case of a 30-year-old female submitted to resection of a right parietal lesion whose histology showed to be an AO. She underwent complementary treatment with chemotherapy and radiotherapy according to the Roger Stupp protocol. Four years after the initial diagnosis, there was tumor recurrence within the superior sagittal sinus, with no evidence of recurrence elsewhere. In the literature, we have found no similar published case reinforcing the rarity of this condition.

Relationship between Clinical Outcomes and Superior Sagittal Sinus to Bone Flap Distance during Unilateral Decompressive Craniectomy in Patients with Traumatic Brain Injury: Experience at a Single Trauma Center / 대한신경손상학회지

OBJECTIVE: This retrospective study was conducted to investigate the relationship between the superior sagittal sinus (SSS) to bone flap distance and clinical outcome in patients with traumatic brain injury (TBI) who underwent decompressive craniectomy (DC). METHODS: A retrospective review of medical records identified 255 adult patients who underwent DC with hematoma removal to treat TBI at our hospital from 2016 through 2017; of these, 68 patients met the inclusion criteria and underwent unilateral DC. The nearest SSS to bone flap distances were measured on postoperative brain computed tomography images, and patients were divided into groups A (distance ≥20 mm) and B (distance < 20 mm). The estimated blood loss (EBL) and operation time were evaluated using anesthesia records, and the time spent in an intensive care unit (ICU) was obtained by chart review. The clinical outcome was rated using the extended Glasgow Outcome Scale (GOS-E) at 3 and 6 months postoperatively. RESULTS: The male to female ratio was 15:2 and the mean subject age was 55.12 years (range, 18–79 years). The mean EBL and operation times were significantly different between groups A and B (EBL: 655.26 vs. 1803.33 mL, p < 0.001; operation time: 125.92 vs. 144.83 min, p < 0.001). The time spent in the ICU and GOS-E scores did not differ significantly between the groups. CONCLUSION: We recommend that when DC is indicated due to TBI, an SSS to bone flap distance of at least 20 mm should be maintained, considering the EBL, operation time, and other outcomes.

Effects of minimally invasive tumor resection under microscope on symptoms improvement, Simpson classification and prognosis in patients with sagittal sinus and falx cerebri meningioma / 中国基层医药

Objective To analyze the effects of minimally invasive tumor resection under microscope on symptoms improvement,Simpson classification and prognosis in patients with sagittal sinus and falx cerebri meningioma.Methods From December 2012 to December 2016,123 patients with parasagittal and falx meningioma in the People 's Hospital of Shanxi Province were randomly divided into two groups according to the digital table.The control group (61 cases) underwent conventional craniotomy,and the study group (62 cases) performed minimally invasive tumor resection.The symptoms improvement,Simpson classification and postoperative recurrence were compared between the two groups.Results The operation time between the two groups had no statistically significant difference (t =1.13,P ＞ 0.05).The intraoperative blood loss in the study group was (119.05 ± 26.94) mL,which was lower than (172.05 ±27.43) mL in the control group (t =10.81,P ＜ 0.01).The postoperative symptoms improvement of movement of limbs (3.22％),epilepsy (4.65 ％),sensory dysfunction (1.61％) in the study group were significantly better than those in the control group (14.75％,31.15％,27.87％) (x2 =5.02,6.34,4.14,all P ＜ 0.05).The Simpson classification of tumor resection rate in the study group was better than that in the control group(x2 =12.23,P ＜0.01).The incidence rates of complications such as epilepsy(0.00％) and intracranial hemorrhage(1.61％),and recurrence rate(0.00％) in the study group were lower than those in the control group(26.23％,27.87％,27.87％)(x2 =4.05,4.14,4.65,all P ＜ 0.05).Conclusion Minimally invasive tumor resection under the microscope can effectively improve clinical symptoms of patients with sagittal sinus and falx cerebri meningioma,which can improve tumor resection rate,effectively reduce the incidence of postoperative complications and recurrence rate.

Study of the signal intensity of superior sagittal sinus in susceptibility weighted imaging / 实用放射学杂志

Objective To study the relevant factors capable of affecting the signal intensity of superior sagittal sinus(SSS)in susceptibility weighted imaging(SWI),and to discover the reason why venous blood in SSS shows high intensity.Methods 26 healthy volunteers and 20 patients with hemodynamic abnormalities of SSS were selected and underwent SWI sequence scanning of 3.0T MR system. Time of echo(TE),angle between SSS and scanning plane and velocity of blood flow were studied as three variables.By controlling two of all three variables at a time,the correlation with the signal intensity of normal SSS were acquired.Results 26 healthy volunteers were scanned with SWI sequence with TE of 20 ms,40 ms and 60 ms.Contrast values(CVs)were calculated based on the signal value of region of interest(ROI).The overall difference was statistically significant(P<0.05),and the differences between each two groups were also statistically significant(P<0.05).In addition,the CV and TE had a negative correlation(r= -0.686,P=0.000).The angle between SSS and scanning plane could affect the signal,and the signal peaked when they were perpendicular to each other.By comparing healthy volunteers with patients with slower blood flow,the difference between the two groups was statistically significant(t=9.684, P<0.05),and a positive correlation had been discovered between the velocity of blood flow and the signal intensity.Conclusion The high signal intensity of healthy persons'SSS in SWI is subject to the time of flight.Furthermore,TE,angle between SSS and scanning plane and velocity of blood flow are three factors which can affect the signal intensity.

Anatomical Variations of Cerebral MR Venography: Is Gender Matter? / 신경중재치료의학

PURPOSE: Knowledge of variations in the cerebral dural venous sinus anatomy seen on magnetic resonance (MR) venography is essential to avoid over-diagnosis of cerebral venous sinus thrombosis (CVST). Very limited data is available on gender difference of the cerebral dural venous sinus anatomy variations. MATERIALS AND METHODS: A retrospective study was conducted to study the normal anatomy of the intracranial venous system and its normal variation, as depicted by 3D MR venography, in normal adults and any gender-related differences. RESULTS: A total of 1654 patients (582 men, 1072 women, age range 19 to 86 years, mean age: 37.98±13.83 years) were included in the study. Most common indication for MR venography was headache (75.4%). Hypoplastic left transverse sinus was the most common anatomical variation in 352 (21.3%) patients. Left transverse sinus was hypoplastic in more commonly in male in comparison to female (24.9% versus 19.3%, p = 0.009). Most common variation of superior sagittal sinus (SSS) was atresia of anterior one third SSS (15, 0.9%). Except hypoplastic left transverse sinus, rest of anatomical variations of the transverse and other sinuses were not significantly differ among both genders. CONCLUSION: Hypoplastic left transverse sinus is the most common anatomical variation and more common in male compared to female in the present study. Other anatomical variations of dural venous sinuses are not significantly differ among both genders.

Risk factors for postoperative provisional paralysis of parasagittal meningioma in the eloquent area / 中国神经精神疾病杂志

Objective The aim of the study was to investigate the related factor of postoperative provisional paraly?sis of parasagittal meningioma in the eloquent area. Methods A retrospective review was conducted on ninety-six pa?tients with parasagittal meningioma in the eloquent area treated by surgery from May 2005 to December 2015. Accord?ing to the diagnostic criteria for postoperative provisional paralysis, patients were divided into postoperative provisional paralysis group(n=31)and non- postoperative provisional paralysis group(n=65). Univariate and multivariate logistic regression methods were used to analyze the data including age, size of tumor,preoperative epilepsy, preoperative periph?eral edema, complete the occlusion of superior sagittal sinus(SSS) by tumor, incision of SSS during surgery, drainage vein damage during surgery. Results Univariate analysis showed that there were significant differences(P<0.05)between these two groups in age(χ2=14.943,P=0.000), preoperative peripheral edema(χ2=4.435,P=0.049), the complete occlu?sion of SSS by tumor(χ2=5.248,P=0.028), incision of SSS during surgery(χ2=5.773,P=0.026), drainage vein damage during surgery(χ2=11.441,P=0.002). Multivariate analysis showed that the factors related to postoperative provisional paralysis were age(OR=8.709,P=0.028), drainage vein damage during surgery(OR=16.242,P=0.012)and complete oc?clusion of SSS by tumor(OR=0.053,P=0.025). Conclusion Age and the drainage vein damage during surgery are the risk factors of postoperative provisional paralysis and complete occlusion of SSS by tumor is the protective factor for the oc? currence of postoperative provisional paralysis.

A Case of Dural Arteriovenous Fistula of Superior Sagittal Sinus after Tamoxifen Treatment for Breast Cancer

We are reporting an unusual case of dural arteriovenous fistula (AVF) of the superior sagittal sinus (SSS) after tamoxifen treatment for breast cancer. A 30-year-old female arrived at the emergency room with a sudden headache and left sided weakness and sensory loss. In her past medical history, she was diagnosed with breast cancer 1 year prior, and subsequently underwent a breast conserving mastectomy with whole breast radiation and adjuvant chemotherapy with tamoxifen. At the time of admission, computed tomography showed a small acute intracerebral hemorrhage at the right parietal cortex, and magnetic resonance imaging showed that a dural AVF at the SSS with a prominent and tortuous venous enhancement along the centrum semiovale was present. Cerebral angiography showed that the dural AVF at the mid-portion of the SSS with meningeal arterial feeding vessels entering the wall of the SSS, then draining through the dilated cortical veins. Our patient had no signs of active malignancy or any abnormalities in her coagulation profile, so it can be concluded that the tamoxifen was the likely cause of the SSS thrombosis and dural AVF. The dural AVF was treated by an endovascular coil embolization for the arterialized segment of the SSS. The patient dramatically recovered favorably from left side motor and sensory deficit. The best clinical approach is to screen potential patients of tamoxifen hormonal therapy and educate them on the sign and symptoms of life threatening thromboembolic events while taking tamoxifen.

Transcranial Direct Middle Meningeal Artery Puncture for the Onyx Embolization of Dural Arteriovenous Fistula Involving the Superior Sagittal Sinus

A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.

Traumatic Dural Venous Sinus Injury / 대한신경손상학회지

OBJECTIVE: The importance of traumatic dural venous sinus injury lies in the probability of massive blood loss at the time of trauma or emergency operation resulting in a high mortality rate during the perioperative period. We considered the appropriate methods of treatment that are most essential in the overall management of traumatic dural venous sinus injuries. METHODS: We conducted a retrospective review of all cases involving patients with dural venous sinus injury who presented to our hospital between January 1999 and December 2014. RESULTS: Between January 1999 and December 2014, 20 patients with a dural venous sinus injury out of the 1,200 patients with severe head injuries who had been operated upon in our clinic were reviewed retrospectively. There were 17 male and 3 female patients. In 11 out of the 13 patients with a linear skull fracture crossing the dural venous sinus, massive blood loss from the injured sinus wall could be controlled by simple digital pressure using Gelfoam. All 5 patients with a linear skull fracture parallel to the sinus over the venous sinus developed massive sinus bleeding that could not be controlled by simple digital pressure. CONCLUSION: When there is a linear skull fracture parallel to the sinus over the dural venous sinus or a depressed skull fracture penetrating the sinus, the surgeon should be prepared for the possibility of potentially fatal venous sinus injury, even in the absence of a hematoma.

A study of 25 cases of cerebral venous sinus thrombosis.

Background: Cerebral venous sinus thrombosis is a rare but dangerous condition, occurring with an incidence of 3-4 cases/ million/ year. It has a higher frequency among patients younger than 40 years of age. Cerebral venous thrombosis occurs 3 times as frequently in women. The symptoms and signs associated with cerebral venous thrombosis (CVT) are relatively nonspecific. Aims & Objective: To study the demographic profile, identify various etiologies different mode of onset and presentations, identify common sites of occlusion and outcome of the patients with CVST. Materials and Methods: Total 25 patients admitted in medical wards with MR venography suggestive of CVST were enrolled. Detailed medical history with general and systemic examination done. Routine and specific investigations carried out. Patients treated with anticoagulation therapy. At time of discharge recovery is graded in form of Modified Rankin Score. Results: Higher incidence in young female of 21 – 30 age group. Male to female Ratio was 1:3.167. Pregnency and puerperium accounts for 36%of total cases. Headache was presenting symptom in all patients. CSF was abnormal in 17 patients. Superior sagittal sinus alone or in combination affected in 72% of cases.52% of patients had complete recovery. Death occurred in 20% of cases. Conclusion: Sinus thrombosis remains a diagnostic challenge and a potentially disabling or lethal disease, but improved diagnosis by recent advances and treatment now result in an excellent outcome for most patients.

The Role of Hyperthyroidism as the Predisposing Factor for Superior Sagittal Sinus Thrombosis

Superior sagittal sinus thrombosis (SSST) is an uncommon cause of stroke, whose symptoms and clinical course are highly variable. It is frequently associated with a variety of hypercoagulable states. Coagulation abnormalities are commonly seen in patients with hyperthyroidism. To the best of our knowledge, there are few reports on the association between hyperthyroidism and cerebral venous thrombosis. We report on a 31-year-old male patient with a six-year history of hyperthyroidism who developed seizure and mental deterioration. Findings on brain computed tomography (CT) showed multiple hemorrhages in the subcortical area of both middle frontal gyrus and cerebral digital subtraction angiography (DSA) showed irregular intra-luminal filling defects of the superior sagittal sinus. These findings were consistent with hemorrhagic transformation of SSST. Findings on clinical laboratory tests were consistent with hyperthyroidism. In addition, our patient also showed high activity of factors IX and XI. The patient received treatment with oral anticoagulant and prophylthiouracil. His symptoms showed complete improvement. A follow-up cerebral angiography four weeks after treatment showed a recanalization of the SSS. In conclusion, findings of our case indicate that hypercoagulability may contribute to development of SSST in a patient with hyperthyroidism.

Complete Paraparesis Following Resection of Parasagittal Meningioma: Recovering Function with an Early Intensive Neurorehabilitation Program

Paraparesis can occur as a primary presentation of brain pathology at the motor strip along the parasagittal region. It could also occur as a neurological complication especially following resection of parasagittal meningioma with infiltration of the superior sagittal sinus (SSS). We report a case of a complete paraparesis immediately following resection of bilateral parasagittal meningioma with infiltration of the middle third of the SSS. A gradual improvement in neurological recovery and functional outcome was observed over a period of one year after undergoing an intensive neurorehabilitation program beginning from the acute inpatient phase post surgery.

Changes of Plasma Concentration of Calcitonin Gene-related Peptide and Substance P after Electrical Stimulation on Dura Mater Adjacent to Sinus Sagittalis Superior in Rats / 中国康复理论与实践

@#ObjectiveTo analyze the changes of plasma concentration of calcitonin gene-related peptide (CGRP) and substance P (SP) after electrical stimulation on dura mater adjacent to sinus sagittalis superior (SSS) in rats.Methods13 rats were randomly divided into control group(n=6) and stimulation group(n=7) in which the dura matter adjacent to SSS was stimulated electrically with square wave of 20 Hz, 4 mA and 250 μs. The plasma concentrations of CGRP and SP in both groups were compared by means of radioimmunity method.ResultsThere was significant difference in the plasma concentration of CGRP between control and stimulation groups (50.60±7.16 pg/ml vs 42.20±4.82 pg/ml, P＝0.029). However, there was no significant difference in the plasma concentration of SP between two groups (308.59±43.07 pg/ml vs 264.60±60.28 pg/ml, P＝0.165).ConclusionPlasma concentration of CGRP decreased after electrical stimulation on dura mater in rats but the concentrations of SP unchanged.

Clinical diagnosis and treatment for superior sagittal sinus thrombosis / 中国基层医药

Objective To discuss the diagnosis and treatment of superior sagittal sinus thrombosis.Methods The early diagnosis and treatment of superior sagittal sinus thrombosis was induced and summarizd,7 cases in our hospital treated from 2005.6 to 2008.9.were analyzed.Results In this investigation,3 cases were puerperal women,and the other 4 had no special medical history.Brain edema of difference degree was found in all cases on CT scans,including sulcus (7 cases),compression of cistern(5 cases) or even disappeared of cistern(2 cases).CT scanning also revealed dense triangle in 2 cases,multiple small encephalomalacia focus of frontal lobe lesions in 3 cases,and sub-arachnoid hemorrhage(SAH) in 2 cases.The digital subtraction angio-grapby(DSA) also was underwent,of 2 superior sagittal sinus not seen,of 4 appear unevenness,of 7 Arterio-venous circulation delayed and of 5 collateral circulation vasodilatation.After treatment,the clinical symptoms and signs of all patients were improved.All of them could be self-supporting.Followed up for 3 years,the mortality was 0,and no one cerebral hemorrhage again.Conclusion The early diagnosis and treatment of superior sagittal sinus thrombosis could reduce the morbidity and mortality, also could improve prognosis.Especially for the one without cerebral hemorrhage,using heparin at the beginning was an effective and safe way.

Thrombosis of the Superior Sagittal Sinus in Behcet's Disease With Vascular and Enteric Involvements

We report superior sagittal sinus thrombosis as a central nervous system presentation of Behcet's disease in a patient with peripheral vascular and enteric involvement. The main symptoms were headache and horizontal diplopia due to intracranial hypertension. T1-weighted MRI with gadolinium enhancement revealed a similar pattern of the "empty delta sign" that is usually seen on brain CT. A magnetic resonance venogram revealed filling defects resulting from the thrombosis. These features are helpful for the noninvasive diagnosis of sagittal sinus thrombosis.