A Case of Superior Sagittal Sinus Thrombosis Presented with Papilledema

This is a case report of superior sagittal sinus thrombosis (SSST), with bilateral papilledema as the initial manifestation.

A 65-year-old male was referred to us with bilateral decreased vision and recurrent blackouts associated with postural change. Although his intracranial pressure was increased, an intracranial space-occupying lesion was not detected by computed tomography (CT). Magnetic resonance imaging (MRI) with a fluid-attenuated inversion recovery (FLAIR) technique and magnetic resonance venography (MRV) findings revealed a thrombosed superior sagittal sinus. Anticoagulation therapy with heparin was started and recurrent blackouts disappeared one month thereafter. Thoracoabdominal CT examination revealed an infiltrative shadow in the right inferior lobe of the lungand was diagnosed as squamous cell carcinoma from biopsy by bronchoscopy. Bilateral papilledema gradually decreased over an 18-month observation period after anticoagulation therapy.

MRV was useful in the diagnosis of SSST in this case of bilateral papilledema with increased intracranial pressure.

Keywords: Cerebral venous sinus thrombosis, Magnetic resonance venography, Papilledema, Recurrent blackouts, Squamous cell carcinoma.