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Updated: Jul 11 2017

Dural Venous Sinuses

  • Snapshot
    • 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.
  • Overview
  • Introduction
    • 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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