What is the management of sagittal sinus thrombosis?

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 whichis raised pressure, increased risk of fits, haemorrhage, alteration ofsensorium, paralysis, etc.2) Treating the clotting process. Aside from treating the cause which haslead to the thrombosis such as oral contraceptives, dehydration etc furtherprogression of the disease is prevented by heparin. It is now known thatprovided reasonable precautions are taken, heparin is useful even in thepresence of brain haemorrhage which can occur in these patients.In the occasional patient who worsens inspite of heparin or takes aprecipitous turn for the worse an urgent intervention to dissolve the clotsusing fine catheters placed in the middle of the thrombosis and instillingurokinase or similar substance may help. In more established clots or "organised clots" a mechanical disruption in association with chemicaldissolution helps.