Occipital Sinus Thrombosis: An Exceptional Case Report

J Stroke Cerebrovasc Dis. 2016 Jun;25(6):e71-3. doi: 10.1016/j.jstrokecerebrovasdis.2016.02.006. Epub 2016 Mar 29.

Abstract

Background: Variations of the dural venous sinuses may result in inaccurate imaging interpretation or complications during surgical approaches. One variation of the dural venous sinuses reported infrequently in the literature is the occipital sinus. We report an exceptional case of occipital sinus thrombosis.

Case report: A 48-year-old right-handed man with a 5-month history of hypertension and chronic renal failure presented with cephalalgia, vomiting, and blurred vision evolving over 48 hours. Neurological examination revealed papillary edema stage 1 with no others abnormalities. An initial brain computed tomography (CT) scan performed was normal. The opening pressure of cerebrospinal fluid (CSF) was 35 cmH2O with normal level of protein and no hypercellularity in CSF analysis. The evolution was marked by the occurrence of generalized tonic-clonic seizure. A second CT scan performed showed a hyperdensity of the occipital sinus. Magnetic resonance imaging and magnetic resonance venography studies confirmed the diagnosis with highlighting the thrombosis of the occipital sinus in association to an ectasia of the torcular. The patient received adequate anticoagulation for 6 months in association to antiepileptic drugs with a good evolution.

Discussion: According to our review, such a thrombosis must be a rare condition, because our literature search has shown a lack of any report describing this condition. Herein, we review the anatomy of the occipital sinus and we illustrate the characteristics of this unusual thrombosis with multiple imaging modalities.

Conclusion: Understanding of the cerebral venous anatomy and recognition of venous variations essentially help when dealing with a pathology, which presents along with a particular venous variation, no matter how rare this combination is.

Keywords: Occipital sinus; dural venous sinuses; thrombosis; venography.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Anticonvulsants / therapeutic use
  • Central Nervous System Vascular Malformations / complications*
  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Cerebral Angiography / methods
  • Computed Tomography Angiography
  • Cranial Sinuses / abnormalities*
  • Cranial Sinuses / diagnostic imaging
  • Epilepsy, Tonic-Clonic / drug therapy
  • Epilepsy, Tonic-Clonic / etiology
  • Humans
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Phlebography
  • Sinus Thrombosis, Intracranial / diagnostic imaging
  • Sinus Thrombosis, Intracranial / drug therapy
  • Sinus Thrombosis, Intracranial / etiology*
  • Time Factors
  • Treatment Outcome

Substances

  • Anticoagulants
  • Anticonvulsants