Pulmonary emboli as a fatal complication of superior sagittal sinus thrombosis was once well recognized in the literature but appears to have been forgotten. The sagittal sinus appeared to be the source of pulmonary emboli in previously reported cases. Even in patients with no evidence of systemic thrombosis, but who have sagittal sinus thrombosis, the possibility of dislodging pulmonary emboli should be strongly considered. We report a case of nontraumatic sagittal sinus thrombosis complicated by multiple pulmonary emboli and a fatal saddle embolism, likely originating from the thrombosed sinus. Our review of the literature between 1942 and 1990 yielded 203 cases of intracranial venous thrombosis. The overall mortality rate was 49.3%. In 23 cases (11.3%), the venous sinus thrombosis was associated with pulmonary emboli and in these the overall mortality rate was 95.6%. In the 203 cases in our review, those patients who received anticoagulation therapy also had a statistically significant better outcome. Therefore, the presence of pulmonary emboli in association with sagittal sinus thrombosis mandates a sober assessment of the need of anticoagulation therapy in the absence of obvious contraindication.

A 41-year-old woman complained of severe headaches and developed quadriparesis and neurogenic bladder. Evaluation disclosed the presence of Sjögren's syndrome complicated by myeloradiculopathy with MRI evidence of cervical cord involvement. Concurrent cerebral venous sinus thrombosis was also noted. Treatment with steroids and warfarin led to clinical improvement and resolution of MRI findings.

Idiopathic intracranial hypertension and low cerebrospinal pressure are 2 conditions that are thought to be on opposite ends of the cerebrospinal pressure spectrum. Headache is the prominent component of both conditions. We describe a patient whose evaluation for idiopathic intracranial hypertension resulted in a postlumbar puncture headache. Although not entirely intuitive, we suggest that the 2 conditions can be present in the same patient.

We describe two patients who developed neuromyotonia of the floor of the mouth after irradiation of a motor branch (V3) of the trigeminal nerve. The neuromyotonia manifested as sustained muscle contraction due to peripheral nerve dysfunction. The neuromyotonia in both patients was controlled with carbamazepine. Radiation-exposed nerves can become symptomatic months or years after completion of radiation therapy.

Antithrombin III (AT-III) and protein C (PC) deficiencies are knoi/n to be associated v/ith a major risk of thrombosis. Before, during and after cardiovascular surgery (CS) AT-III end PC were investigated in plasma samples obtained within the framework of a randomised Cl-esterase inhibitor (Cl-INH)-c.pro-tinin-placebo study in adults undergoing extracornoreel circulation (ECC), and children subjected to ECC and treated with aprotinin. Determination of AT-III and PC activity gave the following results:AT-III: Preoperative values in adults (n = 25) and children (r: = 11) were normal amounting to a median of 92 % and 10C %, res; actively. In adults a steady decrease in AT-III without any difference between the 3 groups occurred durinc ECC rntil the 1st postoperative (po) day where AT-III had faller: to CC % (median). In children the same decrease was observed duri;r ECC, however, after termination of ECC AT-III increased until normal on the 1st day po (median = 85 %) and this difference between adults and children is significant at a p of 0.019.Protein C: Median preoperative values in adults (n = 45) were 111 %, while in children (n = 11) only 48 % were found. During and after surgery in children there was no change in PC, while significant differences were found between the 3 adult groups. In the placebo group and the aprotinin group PC fell to 69 % (median) and 86 % (median), respectively, on the 1st day po. However, in the group receiving CI-INH Concentrate (Immeno) PC increased up to 136 % and only after discontinuation of treat; a-r.t decreased to 92 % (median). The significant rise in PC ir. the CI-INH group is explained by the content of PC in the CI-IMII Concentrate. These findings are indicative of a significant difference in the behaviour of AT-III and PC in children and adults, and suggest that the administration of CI-INH Concentrate may reduce the risk of thrombosis associated with ECC.