Q: What is the management of sagittal sinus thrombosis?

A:Broadly, the treatment of sagittal sinus thrombosis may be divided into two parts: 1) Treating the effects on the brain of a sagittal sinus thrombosis which is raised pressure, increased risk of fits, haemorrhage, alteration of sensorium, paralysis, etc. 2) Treating the clotting process. Aside from treating the cause which has lead to the thrombosis such as oral contraceptives, dehydration etc further progression of the disease is prevented by heparin. It is now known that provided reasonable precautions are taken, heparin is useful even in the presence of brain haemorrhage which can occur in these patients. In the occasional patient who worsens inspite of heparin or takes a precipitous turn for the worse an urgent intervention to dissolve the clots using fine catheters placed in the middle of the thrombosis and instilling urokinase or similar substance may help. In more established clots or "organised clots" a mechanical disruption in association with chemical dissolution helps.