Cerebral venous sinus thrombosis: a diagnostic challenge.

BACKGROUND: Cerebral venous sinus thrombosis (CVT) is a potentially serious but treatable disorder that has been underdiagnosed in the past. Delay in diagnosis and treatment of this disorder has resulted in the death of one of our patients. AIM: To review the local experience with CVT in order to identify factors that may allow diagnosis and appropriate treatment decisions to be made more readily in the future. METHODS: A retrospective review of all cases of CVT diagnosed or treated at Auckland Hospital between 1990 and 1999. RESULTS: Twenty-five cases of CVT were identified. The number of cases diagnosed increased from less than one per year in 1990-94 to eight in 1999. Clinical signs at presentation included headache (96%), focal neurological deficits (60%), seizures (40%) and papilloedema (43%). Delayed diagnosis after admission to hospital occurred in two young women presenting with neurological symptoms during pregnancy or puerperium, in two cases in whom focal symptoms were not explained by negative computed tomography and in five cases presenting with intracerebral haemorrhage. Twenty patients received anticoagulant therapy and their condition remained stable or improved after treatment. CONCLUSIONS: The diagnosis of CVT should be considered in women with any neurological symptoms during pregnancy or puerperium and in all cases of unexplained intracerebral haemorrhage. CVT should also be considered in cases of recent onset and progressive headache, particularly when associated with focal neurological symptoms or signs, seizures or papilloedema. Magnetic resonance imaging with magnetic resonance venography is the investigation of choice. Anticoagulation with heparin remains the mainstay of treatment, even in the presence of intracerebral haemorrhage.

Correlation of CAT scan and visual field defects in vascular lesions of the posterior visual pathways.

Thirty-nine patients with various types of isolated homonymous hemianopias resulting from ischaemic lesions in the posterior parts of the cerebral hemisphere was examined by CAT scanning. Most had localised low density lesions withing the distribution of the posterior cerebral artery. The location of the lesion (deduced from a separate anatomical study of postmortem brain cut in the plane of the CAT scanner) was correlated with visual field defects. Lesions giving rise to quadrantic defects were smaller than those causing total hemianopias; lower quadrantic defects tended to occur in superior cuts and vice versa. Macular sparing was associated with survival of the occipital pole in some instances. Bilateral cases had a higher prevalence of associated defects.

Neurological involvement in the epidermal naevus syndrome.

The case of a left handed girl aged 18 years suffering from the "epidermal maevus syndrome" is described. She presented with dysphasia, transient left hemiparesis, and sensory symptoms due to an occlusion of the right internal carotid artery. Arterial occlusion, abnormal retinal vessels, and Raynaud's phenomenon have not been previously documented. The neurological complications of this syndrome are discussed. It is suggested that the arterial occlusion may have been caused by a dysplastic artery.

Gold encephalopathy.

Encephalopathy is described developing in a 42 year old man who was receiving gold treatment for rheumatoid arthritis.