• A previously healthy 29-year-old female presents with a progressive, diffuse headache and vomiting. She has no active illnesses, takes a multivitamin, and an oral contraceptive. On exam, there is edema on the scalp, papilledema on fundoscopy, and bilateral muscle weakness. Noncontrast head CT shows a hyperdense lesion in a part of the superior sagittal sinus.

Dural Venous Sinuses in relation to the skull, falx cerebri and tentorium

  • Structure
    • reflections in dura matter where meningeal and periosteal layers split
  • Function
    • return blood from cerebral veins to internal jugular vein
  • Main examples
    • superior sagittal sinus
      • superior to falx cerebri
      • tributary of the confluence of sinuses
    • inferior sagittal sinus
      • inferior to falx cerebri
      • tributary to the straight sinus
    • cavernous sinus
      • lateral to the sella turcica
      • tributary of the transverse sinus and sigmoid sinus
      • contains CN III, IV, V1, V2, VI, and internal carotid
      • clinical correlate
        • cavernous sinus thrombosis
          • spread of infection from superficial and deep face to cavernous sinus
          • present with symptoms relating to compression of cranial nerves
            • CN VI usually affected first
              • patient cannot abduct eye
  • Clinical importance
    • venous sinus thrombosis → increases intracranial pressure
      • obstruction → increases venous pressure
      • consequences include:
        • decreases capillary perfusion pressure
        • impairs blood brain barrier → vasogenic edema
        • impairs CSF reabsorption
        • brain parenchymal damage
        • venous hemorrhage
      • causes include:
        • prothrombotic diseases
          • e.g., factor V leiden mutation, protein C or S deficiency, antithrombin deficiency
        • oral contraceptives (OCP) 
        • pregnancy
        • malignancy

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