Dural sinus thrombosis is an uncommon lesion among central nervous system diseases and sagittal sinus thrombosis is the most common site of venous occlusion. A wide margin of clinical features could be presented in this entity from asymptomatic patients with spontaneous resolution to severe coma and death. The mean symptoms included headache, seizures, hemiparesis, and focal deficit. Cerebral angiography in the late phase leads to localizing the exact zone of thrombosis. Treatment should be guided to prevent progression of neurological deterioration with the use of heparin for dissolving the clot and phenytoin.



We report two cases, the first in a 9 year old boy with history of Down syndrome and seizures in the first 4 years of life. He had a period of gastroenteritis 2 weeks before admissions that was characterized by sudden tonicoclonic seizures with right hemiparesis and hyperreflexia. The laboratory test was normal and magnetic resonance image showed hyperintensity areas in left frontoparietal and right parietal regions in T1 and T2 images in relation to ischemia cerebral angiography in venous phase revealed an are of deficit of blood flow within the sagittal sinus in relation to thrombosis.



Treatment with heparin and phenytoin was carried out and the patient were discharged from the hospital in better neurological conditions. The second case concerned a sixteen-year old healthy female. She began suddenly with upper right extremity paresis, tonicoclonic seizures, disartria, and right central facial paralysis. Computer tomography (CT) scan revealed a large area of hypodensity in left frontoparietal area with edema. Magnetic resonance image in both T1 and T2 sequences howed hyperintensity in the same region, and the angiographic cerebral study in venous phase revealed the site of venous obstruction within the sagittal sinus.



Laboratory tests revealed an antiphospholipid MPL of 76 and diagnosis of sagittal sinus thrombosis secondary to antiphospholipid syndrome was made. Treatment with phenytoin and heparin was initiated and the patient was discharged from the hospital with no neurological deficit with acenocumarin. cal deficit with acenocumarin. We conclude that TSLS could have a good prognosis if treatment is started as soon possible with anticoagulants and fibrinolytics. Cerebral angiography is mandatory for diagnosis and prevents delay in treatment.



Key words: Sagittal sinus thrombosis, Dehydration, Antiphospholipid syndrome, Cerebral angiography.





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