Cerebral venous sinus thrombosis and acute subarachnoid hemorrhage: a retrospective study on diagnosis, treatment prognosis of 11 patients

Most nontraumatic subarachnoid hemorrhage (SAH) is resulted from ruptured aneurysm. Few cerebral venous sinus thrombosis (CVST) may appear after acute SAH with similar clinical manifestations as aneurysm bleeding, raising difficulties for SAH diagnosis in clinics. Retrospective analysis of 88 patients with CVST in our hospital from March 2008 to March 2015 was carried out. Among them, the radiologic characteristic, therapeutic strategies and prognosis of 11 patients with SAH as initial manifestation were analyzed. In total, 7 patients received pure heparin anticoagulant treatment and 4 patients received intrasinus thrombolytic treatment with urokinase. Non-enhancement CT or MRI proved that SAH localized at the parasagittal or dorsolateral cerebral convexity. Empty delta sign was present in 5 cases by enhanced CT. CVST involved superior sagittal sinus in 9 patients, lateral sinus in 5 patients, sigmoid sinus in 3 patients, straight sinus in 1 patients and cortical veins in 4 patients under magnetic resonance venography (MRV) or digital subtraction angiography(DSA). Complete recanalization of the occluded sinus or cortical veins was evident in 8 patients and partial recanalization was observed in 2 patients. Nonrecanalization was still in 1 patient who received craniotomy hematoma craniectomy because of secondary intracranial hemorrhage after intrasinus thrombolytic therapy. All patients except one exhibited satisfactory outcome. CVST should be considered in patients with nonaneurysmal SAH, based on which early diagnosis and treatment can be applied. CT, MRI and MRV imaging are effective for early diagnosis and anticoagulants and endovascular treatment is safe and effective against CVST.