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The first description of thrombosis of the cerebral veins and sinuses is attributed to the French physician Ribes, who in 1825 observed thrombosis of the sagittal sinus and cerebral veins in a man who had had seizures and delirium. [29] Until the second half of the 20th century it remained a diagnosis generally made after death. [30]
The superior sagittal sinus (also known as the superior longitudinal sinus), within the human head, is an unpaired dural venous sinus lying along the attached margin of the falx cerebri. It allows blood to drain from the lateral aspects of the anterior cerebral hemispheres to the confluence of sinuses .
The sinuses can be injured by trauma in which damage to the dura mater, may result in blood clot formation (thrombosis) within the dural sinuses. Other common causes of dural sinus thrombosis include tracking of infection through the ophthalmic vein in orbital cellulitis .
It is seen as dural wall enhancement in the absence of intra-sinus enhancement (there is no enhancement in the lumen of the dural sinus). [1] This is due to the presence of a blood clot in the dural venous sinuses. The dural venous sinuses drain blood from the brain to the internal jugular veins, which in turn drains blood to the heart.
The confluence of sinuses shows significant variation. [1] Most commonly, there is a continuous connection between all of the sinuses. [1] [2] A very common variant is the superior sagittal sinus only draining into the right transverse sinus - more rarely, it may also only drain into the left transverse sinus.
Dural venous sinus thrombosis (DVST) and cortical venous thrombosis (CVT) commonly presents with headache, increased intracranial pressure, or seizures. DVST is more common than CVT. DVST are frequently caused by infections in the skull base, dehydration, thrombophilia, meningioma, and other dural tumours. [3]
Non-developmental syndromes also directly or indirectly affect the Great Cerebral Vein of Galen, although they are extremely rare. These include superior vena cava syndrome (SVCS), and thrombosis of the lateral sinus, superior sagittal sinus, internal jugular vein, or of the Great Cerebral Vein of Galen itself. [citation needed]
Confined to sinus wall, typically after thrombosis. Type II IIa - confined to sinus with reflux (retrograde) into sinus but not cortical veins. IIb - drains into sinus with reflux (retrograde) into cortical veins (10-20% hemorrhage). Type III Drains direct into cortical veins (not into sinus) drainage (40% hemorrhage). Type IV