A 21-year-old woman presenting with rapid mental status change

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A 21-year-old woman presenting with rapid mental status change leading to coma. MRI, sagittal T1-weighted image, showing hyperintense
thrombus within the posterior half of the superior sagittal sinus (SSS) (arrows) and straight sinus (arrowheads).
MRV, sagittal reconstruction, confirming the obliteration of the SSS and the partial occlusion of the straight sinus. Note the presence of
engorged parasagittal veins trying to act as collateral pathways for the occluded SSS (arrowheads).
MRI, coronal T1-weighted image post gadolinium administration. The thrombus is seen as an intraluminal defect within the sinus. Note again
engorged parasagittal venous channels serving as collateral pathways (arrowheads).
DSA, selective SSS venogram, lateral projection, obtained during endovascular therapy. The tip of the catheter has been advanced proximally to
the thrombosed segment. The venogram documents the patent portion of the sinus, with drainage essentially directed towards the pterygoid
plexus via the sphenoparietal sinus (arrowhead). The parasagittal collateral veins are seen as well.
The flattening of the posterior aspect of both eyes (arrowheads) associated with papilledema from increased intracranial pressure with
pseudotumor cerebri. Note, increased subarachnoid space surrounding the orbital portions of both optic nerves.
Table. Shunting
Study (Author, Year)
(McGirt, Woodworth et
al. 2004)
N
42
Shunt Type
79LP+ 36 VP
Headache
Papilledema
Vision
Relief
Resolution
Improvement
40 (95)
NA
NA
VP Shunts
Complications*
FU
(Mo)
VP Shunt16(44)
Overdrainage 3(8)
24
Distal catheter
migration 1(3)
LP Shunt
Overdrainage 13(16)
Distal catheter
migration 4(5)
Infection 3(4)
Back Pain 4(5)
(Abubaker, Ali et al.
2011)
25
10 VP +15 LP
LP 11/13
(85)
VP 9/10
(90)
6/7
LP Shunt
VP Shunt 60%
Visual Acuity
Improved
LP Shunt 30%
6/6(100%)
Visual Field
Improved
48
10/10(100%)
VP Shunt
Acuity Improvement
4/4(100%)
Visual Field
Improvement
4/4(100%)
(Tulipan, Lavin et al.
1998)
7
VP only
6/7 (89)
5/7
complete
resolution
NA
0 (0)
LP Shunt
LP Shunt
2/7
resolving
(Tarnaris, Toma et al.
2011)
29
29 Primary
shunts Shunts
25 LP + 5VP
(Primary
shunts)
LP
VA
17/25 (71)
Improve
10(42)
VP 3/5(60)
No Change/ Worst
Complications 6(24)
Revision 10(40)
14(58)
VP Shunt
VP Shunt
9
Improve 2(40)
Complications 1(11)
No Change/ Worst
Revision 2(22)
3(60)
(Bynke, Zemack et al.
2004)
17
VP Only
16/16
VA improved
(100)
Improved 3 eyes,
Unchanged 26 eyes
Non-significant
changes 5eyes.
Proximal
Malpositioning 1(6)
Distal Malfunction
6(35)
Infection 2(17)
Visual fields
Normal 11 eyes,
Improved 11 eyes
Unchanged 12 eyes.
(Rosenberg, Corbett et
al. 1993)
37
(Johnston, Besser et al.
36
73 LP +9
Ventricular
Shunt Failure
LP (11%) VP (14%)
32/32
37 /37 (100)
LP Shunt
78
1988)
(100%)
eyes
Obstruction 18(49)
Infection 4(11)
Overdrainage11 (29)
Sciatica 1(3)
VP Shunt
Obstruction 4(80)
Over-drainage 1(20)