OUTCOME IN NONSEPTIC SPONTANEOUS SUPERIOR SAGITTAL SINUS THROMBOSIS IN ADULTS - A 14-YEAR EXPERIENCE

We reviewed clinical features and outcomes of 16 patients (3 men and 13 women) aged 18-68 years, with nonseptic, nontraumatic superior sagittal sinus thrombosis (SSST). Most common risk factors were oral contraceptives, a postpartum state or malignancy. Two patients were noted to have a 'lupus anticoagulant'; 1 of these had prior venous thrombosis in the legs and recurrent spontaneous abortions but no antiphospholipid antibodies. Five patients had poor outcomes, including 4 deaths. Of the 11 patients with good outcomes, 9 had no residual deficits. Intracranial hemorrhage was noted on initial CT in 3 patients. One had hemorrhagic transformation of a bland cerebral infarction without use of anticoagulants, as did 1 after receiving only 1,600 IU of intravenous heparin. Of the 11 patients who had a good outcome, 5 received full-dose intravenous heparin. Of the 5 patients who had a poor outcome, none received full-dose heparin due to the presence of either a large infarction or hemorrhage. Due to its infrequent occurrence and heterogenous nature, recommendations regarding heparin therapy for patients with nonseptic SSST should be individualized.