3 Questions
What is the empty delta sign, and why is it a sign of sagittal sinus thrombosis?
The empty delta sign is a central, darker-filling defect, seen on axial CT and MRI scan images. It is a sign of sagittal sinus thrombosis because it is an indication of obstruction of venous drainage, which can cause elevated intracranial pressure.
What are the treatment options for sagittal sinus thrombosis?
The usual treatment for sagittal sinus thrombosis is anticoagulation therapy. However, this is controversial when hemorrhage has occurred. Additionally, seizures and elevated intracranial pressure should be treated when present.
Describe the radiological signs of sagittal sinus thrombosis.
Radiological signs of sagittal sinus thrombosis may include the empty delta sign, increased density of the sagittal sinus on CT due to coagulated blood, or increased T1 signal on MRI. A more definitive study such as magnetic resonance venography (MRV) or a conventional angiogram may be needed to confirm the diagnosis.
Study Notes
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Sagittal sinus thrombosis is a rare condition that is often associated with one of the hypercoagulable states listed in Table 10.5.
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The condition occurs with increased frequency in pregnant women and within the first few weeks post partum.
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Obstruction of venous drainage usually causes elevated intracranial pressure.
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Back pressure in cortical veins can cause parasagittal hemorrhages.
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In addition, the increased venous pressure can decrease cerebral perfusion, leading to infarcts.
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Seizures are common.
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Patients often have headaches and papilledema, and they may have depressed level of consciousness.
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The superior sagittal sinus can normally be seen as a triangular region on axial CT and MRI scan images.
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In sagittal sinus thrombosus, there may be a central, darker-filling defect, called the empty delta sign.
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More subtle radiological signs of sagittal sinus thrombosus include increased density of the sagittal sinus on CT due to coagulated blood, or increased T1 signal on MRI.
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In suspected sagittal sinus thrombosus, regardless of whether these subtle radiological findings are present, a more definitive study should be performed, such as magnetic resonance venography (MRV) or a conventional angiogram.
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Treatment usually involves anticoagulation therapy, although this is controversial when hemorrhage has occurred.
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Seizures (see KCC 18.2) and elevated intracranial pressure (see KCC 5.3) should be treated as well, when present.
Test your knowledge about the rare condition of sagittal sinus thrombosis, including its causes, clinical features, radiological signs, and treatment. Learn about the association with hypercoagulable states, increased frequency in pregnant women, and the importance of definitive imaging studies.
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