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Tuesday, January 8th 2013

Venous Sinus Thrombosis

In case you missed it our Secretary of State, Hilary Clinton, has a cerebral venous sinus thrombosis. Such may be a consequence of her mild traumatic brain injury earlier in December. But considering these can be relatively asymptomatic things, especially in older individuals, and that the madame Secretary has a likely procoaguable disposition, considering her history of deep venous thrombosis, it may just be this clot in her right transverse sinus was found incidentally on a follow up brain MRI.

The Heart has a good video on Mrs. Clinton’s condition. An NEJM review article from 2005 can be found here (PDF).

In general these are clots in the large draining veins from the brain. They’re associated with procoaguable states including a strong association with pregnancy; as well as with cancer and trauma and infections of the inner ear amongst other things but in at least 15% and perhaps as many as 30 or 40% of cases no underlying risk factor or etiology is identified. They can lead to raised intracranial pressure by cerebral edema in the areas where blood backs up and by affecting the reabsorption of cerebral spinal fluid. Raised intracranial pressure can have relatively non-specific findings including headache, nausea, the consequences of papilledema. At times they can lead to frank venous inarcts; venous strokes in the brain. These strokes can even be hemorrhagic. his can lead to more devastating consequences. Or they can be asymptomatic.

As with venous clots elsewhere the treatment is generally anticoagulants. And it appears Mrs. Clinton is back on coumadin, although there are other, newer oral anticoagulants that could serve the same treatment. Typically it would be expected for her to continue treatment for at least six months, depending on what repeat imaging and exam shows.

My thoughts are with her as she deals with this.