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Superior sagittal sinus thrombosis caused by calvarial tuberculosis: case report.

Sundaram PK, Sayed F

Department of Neurosurgery, Goa Medical College, Bambolim, India. ponrajks@sancharnet.in

OBJECTIVE: Tuberculosis affects the central nervous system in various ways but has not been reported to cause venous sinus thrombosis. In this case report, extensive calvarial tuberculosis caused compression and occlusion of the superior sagittal sinus in an adult man. Early diagnosis combined with surgical and medical treatment resulted in cure of the disease. CLINICAL PRESENTATION: A 34-year-old man presented with a nonhealing sinus in the frontal area after a trivial injury without any neurological deficits or features of raised intracranial pressure. Magnetic resonance imaging scans showed evidence of extensive bilateral extradural granulations, bone destruction, and thrombosis of the anterior half of superior sagittal sinus. INTERVENTION: The affected bone and extradural granulations were surgically excised. Histopathology showed tuberculous osteomyelitis, and the patient received anti-tuberculous treatment, after which he had a good recovery. CONCLUSION: Calvarial tuberculosis as a cause of sagittal sinus thrombosis is a rare condition and is reported here for the first time, to our knowledge. Surgical excision of the compressing granulations followed by medical treatment is curative without sequelae if the intervention is performed before the disease extends intradurally.

Published 6 April 2007 in Neurosurgery, 60(4): E776; discussion E776.
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