Intracranial sinus thrombosis

A 15 year old black male had developed headache six days earlier. By the time he patient came to the emergency room the headache had become unbearable and was associated with photophobia, a low grade fever and lower back pain. Except for some resistance to passive movements, the physical examination revealed no objective abnormal findings. Examination of the CSF excluded meningitis and subarachnoid hemorrhage. Other conditions to be considered included disorders of the cervical spine, tumors of the posterior fossa and neighboring infections. CT scan and MRI of the head showed that the patient had venous sinus thrombosis. Disorders associated with a hypercoagulable state or with a risk of thrombosis (protein C, protein S or antithrombin 3 deficiency, polycythemia, lymphoproliferative disorders, sickle cell disease) were excluded and no evidence of predisposing factors was found. The patient was anticoagulated with heparin initially and then with coumadin. Follow-up CT scan and MRI showed resolution of the thrombosis within a few days. Anticoagulation was to be continued for six months.