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NeuroImages

Figure. Venous swelling at the forehead in the supine (A) but not the upright (B) position in a patient with sinus venous thrombosis. Venous drainage in the angiogram (supine position, C) revealed drainage of the superior sagittal sinus along the superficial middle cerebral vein and along the emissary veins through the diploe.

Caput medusae after sinus venous ure, B). This phenomenon may be explained by the hin- thrombosis dered venous outflow along the internal jugular vein, which has been suggested to be the predominant cerebro- Bernd–Ulrich Meyer, MD, Karl–Titus Hoffman, MD, venous drainage way in the supine position.1 The venous Berlin, Germany angiogram (supine position) revealed drainage of the supe- A 62-year-old woman was admitted with a 2-month his- rior sagittal sinus mainly along the superficial middle ce- tory of headache, impaired vision, and phosphenes. MRI rebral vein (see figure, C, arrow) and along the emissary and cerebral angiography revealed thrombosis of the poste- veins through the diploe. In the upright position the spinal rior part of the superior sagittal sinus, the straight sinus, epidural veins may open as an additional drainage path- sinus confluence, and bilaterally the transverse sinus. Un- way and may improve cerebral venous drainage.1 der anticoagulation, 6 months later the veins were par- tially recanalized. Since the patient’s first admission to the hospital, the veins on her hairless forehead were swollen, 1. Valdueza JM, Münster T von, Hoffman O, Schreiber S, Einhaüpl KM. presenting as a “caput medusae” when she was lying on Postural dependency of the cerebral venous outflow. Lancet 2000;355: her bed (figure, A) but not when she was sitting (see fig- 200–201.

1376 Copyright © 2001 by AAN Enterprises, Inc. Caput medusae after sinus venous thrombosis Bernd-Ulrich Meyer and Karl-Titus Hoffman Neurology 2001;57;1376 DOI 10.1212/WNL.57.8.1376

This information is current as of October 23, 2001

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