Sinus Thrombosis (Venous Sinus Thrombosis) (Sagittal Sinus Thrombosis)

Overview
Symptoms & Diagnosis
Treatment

What is Sinus Thrombosis?

Sinus thrombosis, or venous sinus thrombosis, is a rare type of blood clot found within the dural venous sinuses. The condition is often difficult to diagnose because symptoms vary from person to person depending on the location of the clot.

Types of sinus thrombosis

There are three types of venous sinus thrombosis:

Cavernous sinus thrombosis (CST) — The cavernous sinuses are the most centrally located of the dural sinuses. Their irregular shape and location at the base of the skull make them a primary target for infection. CST is often the result of:

Bacterial infection
Trauma
Ear infection
Infection of the maxillary teeth

Lateral sinus thrombosis — This type of clot is usually associated with bacterial infections in the mastoid sinus. Antibiotic treatments have made this type of clot uncommon.
Superior sagittal sinus thrombosis — Multiple veins empty into the sagittal sinus, making it the largest venous channel in the brain. Because of its size, clots here are rare.

UPMC neurosurgeons may recommend a combination of surgical and nonsurgical approaches to treating sinus thrombosis.

Diagnosing Sinus Thrombosis

Symptoms of sinus thrombosis

Your doctor will perform a physical exam and ask you about any symptoms you are experiencing. Symptoms of venous sinus thrombosis may include:

Weakness
Headaches
Pain in the sinus area
Pain or pressure in the ear
Loss of vision, double vision, or blurred vision
Swelling around the eyes

Tests for diagnosing sinus thrombosis

Your doctor also may want you to have imaging studies to confirm the diagnosis. These tests will include:

CT scan
MRI scan
Angiography

Sinus Thrombosis Treatment

Removing clots

Clot removal using catheters and other specialized equipment, antibiotics, and anticoagulation drugs are the main methods used for the treatment of venous sinus thrombosis.

Your physician may recommend one or a combination of these treatments.

High doses of intravenous antibiotics may be used to stop the spread of infection if it is identified as the source of the problem.

People are usually placed on intravenous antibiotics for a minimum of three weeks, because the clot often resists penetration of the antibiotics.

Additional treatments

People with severe symptoms caused by sinus thrombosis can be treated by an endovascular procedure in order to mechanically open the sinus or with the use of medications called thrombolitics.

Some patients may need a ventricular peritoneal shunt procedure to keep the intracranial pressure normalized.

Neurosurgery at UPMC: A powerful team approach
Dr. Robert M. Friedlander discusses the team approach to treating neurosurgical patients.