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🧠 Superior Sagittal Sinus Thrombosis (SSST) is a rare but important cause of stroke-like presentations, seizures, or unexplained headaches.
A high index of suspicion is crucial, especially in young women with risk factors. 🚨
📌 About
- SSST = clot formation in the superior sagittal sinus, the main venous drainage channel of the brain.
- Presents variably → can mimic stroke, epilepsy, or encephalopathy.
- Early diagnosis is vital as treatment dramatically improves outcome.
⚠️ Aetiology
- More common in 👩 young females, esp. during pregnancy, puerperium, or OCP use.
- Underlying thrombophilia (e.g. Factor V Leiden, antiphospholipid syndrome).
- Other causes: dehydration, local infections (sinusitis, otitis), head trauma, malignancy.
🩺 Symptoms & Signs
- 💢 Headache: Severe, progressive, sometimes positional.
- ⚡ Seizures: Focal or generalized (often new onset in young adults).
- 🌀 Altered consciousness: Confusion → drowsiness → coma in severe cases.
- 🧑⚕️ Stroke-like deficits: Hemiparesis, aphasia, or visual field defects (but atypical for arterial stroke pattern).
- 🌟 Papilloedema: May be seen due to raised intracranial pressure (ICP).
🔬 Investigations
- Bloods:
- FBC (polycythaemia, infection).
- U&E (dehydration), ESR/CRP (inflammation).
- CT Brain:
- May be normal in early stages.
- Delta sign (triangular filling defect) can be seen in posterior sagittal sinus.
- May show venous infarct ± haemorrhage.
- 🧲 MR Venography (MRV): Gold standard → filling defect in superior sagittal sinus.
- 🧬 Thrombophilia screen: Factor V Leiden, prothrombin mutation, antiphospholipid antibodies.
- Malignancy screen: CT CAP, mammography, etc. if risk factors present.
💊 Management
- 🩸 Anticoagulation: IV unfractionated heparin or LMWH even if haemorrhagic transformation present. Improves survival and outcome.
- 🧪 Catheter-directed thrombolysis: Considered in refractory cases with severe deficits.
- 📆 Long-term anticoagulation: Warfarin or DOACs for 3–12 months depending on risk factors.
- 💊 Steroids: ❌ Not recommended (no proven benefit).
- ICP management if raised (head elevation, osmotic therapy, ICU monitoring).
📉 Prognosis
- With prompt anticoagulation → good recovery in most cases.
- Delayed diagnosis → risk of permanent disability or death.
- Recurrence risk higher in those with uncorrected thrombophilia.
