A Case of Sinus Thrombosis Causing Hemorrhagic Infarction

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Abstract
The patient, a 48-years-old housewife, was admitted with complaints of severe headache, intractable nausea and vomiting. She had been treated as a case of alveolar pyorrhea till one month ago. She had suffered from chills and was shivering with high fever about 10 days ago. On admission, physical examination showed dehydration and cachexia, and laboratory data revealed inflammation. There were left hemihypesthesia and mild papilledema. Spinal puncture revealed watery clear fluid with initial pressure of over 500 mm H2O. Computed tomogram (CT) demonstrated a high density area suggesting hemorrhage which was surrounded with low density area in the right temporal lobe. Bilateral carotid angiogram showed no filling of superior sagittal sinus and right transverse sinus. Despite use of hypertonic mannitol solution, steroid and antibiotics, she became semicoma tose with right hemiparesis. Emergent right temporal craniectomy disclosed massive brain swelling and intracerebral hematoma in the temporal lobe. Post-operative course was unfavorable. CT revealed multiple intracerebral hematomas in both hemispheres. She died at the eighth day after operation. At autopsy, revealed swelling of right cerebral hemisphere with right uncal herniation. Horizontal section showed massive multiple hemorrhages in the subcortical white matter and numerous petechiae in both cerebral hemispheres. Superior sagittal sinus and right transverse sinus were thrombosed. Few reports of computed tomogram related to sinus thrombosis are found. In our case, CT revealed the multiple foci of increased absorption surrounded with a relatively large low density area. These foci, examinated by print out data, were not homogeneous nor regular, characteristic of hemorrhagic infarction.

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