Local Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

A 36-year-old woman, who took oral contraconceptives for several years, presented with acute onset severe headache, vomiting, and generalized seizure, and slipped into coma. A, CT scan revealed intracranial hemorrhage and infarct. B, DSA revealed features of extensive cerebral venous sinus thrombosis involving superior sagittal sinus, straight sinus, transverse sinus, and deep venous system. C, One microcatheter was advanced into the superior sagittal sinus, and another microcatheter was advanced into the straight sinus (arrows show the mark of microcatheter). D, MRV showed complete recanalization of superior sagittal sinus, straight sinus, transverse sinus, and deep venous system after 7-day local urokinase administration. The patient was asymptomatic at the time of discharge.