Visual diagnosis in emergency medicine| Volume 41, ISSUE 4, e95-e98, October 2011

Transverse Sinus Thrombosis with Hemorrhagic Venous Infarction Treated with Thrombectomy, Endovascular Tissue Plasminogen Activator, and Systemic Anticoagulation

  • Shane M. Summers
    Reprint Address: Shane M. Summers, md, Department of Emergency Medicine, UC Irvine Medical Center, 101 The City Drive South, Orange, CA 92868
    Department of Emergency Medicine, Brooke Army Medical Center, Ft. Sam Houston, San Antonio, Texas
    Search for articles by this author
Published:February 24, 2009DOI:
      The patient was a 43-year-old otherwise healthy woman who presented to the Emergency Department (ED) with complaint of 2 weeks of constant and progressively worsening right fronto-parietal headache. She was seen in the primary care clinic the day before presentation and was treated for presumed right maxillary sinusitis with amoxicillin-clavulanate, ketorolac, and fluticasone. The patient awoke the morning of her ED visit with sudden onset of the worst headache of her life. She described mild photophobia, nausea and vomiting for the past 2 days, subjective fevers and chills, and nasal congestion. She denied any prior history of headaches or migraines, stiff neck, vision changes, aura, focal weakness, trauma, purulent nasal discharge, intravenous drug use, or history of malignancy. She had no significant past medical or surgical history, and her only regular medication was drospirenone and ethinyl estradiol, which she started 2 months prior for oral contraception. She denied smoking, and drank alcohol socially. There was no family history of migraines or clotting disorders.
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