What are the symptoms of a transverse sinus thrombosis?

Symptoms of Transverse Sinus Thrombosis

The most common symptoms of transverse sinus thrombosis include headache (present in nearly 90% of patients), ear or mastoid pain, increased intracranial pressure signs (such as papilledema and diplopia), and focal neurological deficits including hemianopia, contralateral weakness, and aphasia. 1

Clinical Presentation

Primary Symptoms

• Headache characteristics:
  • Present in 90% of patients with cerebral venous thrombosis (CVT) 1
  • Typically severe (83%) and throbbing (70%) 2
  • Often has sudden onset (57%) and is non-remitting (87%) 2
  • May progress in severity over days to weeks 1
  • Can be the sole manifestation in up to 32% of patients 2

Location-Specific Symptoms for Transverse Sinus Thrombosis

• Pain in the ear or mastoid region 1
• Symptoms related to underlying middle ear infection (if present):
  • Constitutional symptoms
  • Fever
  • Ear discharge 1
• Increased intracranial pressure signs:
  • Papilledema
  • Diplopia (from sixth nerve palsy) 1
  • Distention of scalp veins 1
• Focal neurological deficits:
  • Hemianopia
  • Contralateral weakness
  • Aphasia (due to cortical involvement) 1
• Unilateral hearing loss and tinnitus (in some cases) 3

Distinguishing Features of Cerebral Venous Thrombosis

• Seizures: Focal or generalized seizures occur in approximately 40% of patients 1
• Bilateral brain involvement: Not uncommon due to the anatomy of cerebral venous drainage 1
• Temporal pattern:
  • Acute onset (<48 hours) in 37% of patients
  • Subacute onset (>48 hours to 30 days) in 56% of patients
  • Chronic onset (>30 days) in 7% of patients 1

Diagnostic Challenges

• Delays in diagnosis are common (median delay from symptom onset to diagnosis is 7 days) 1
• Isolated headache without focal neurological findings occurs in up to 25% of patients, presenting a significant diagnostic challenge 1
• Symptoms may mimic other conditions like idiopathic intracranial hypertension 1

Warning Signs of Severe Thrombosis

• Rapid neurological deterioration 1
• Altered level of consciousness 1
• Progressive focal deficits (aphasia, hemiparesis) 1
• Coma 4

Complications

• Venous infarction or hemorrhage leading to additional focal deficits 1
• Increased intracranial pressure complications 5
• Hemorrhagic infarction occurs in approximately 40% of cases 5
• Hydrocephalus occurs in approximately 10% of cases 5

Key Diagnostic Considerations

When a patient presents with severe, progressive headache, especially with ear pain or mastoid tenderness and any neurological symptoms, transverse sinus thrombosis should be considered. The combination of headache with papilledema or diplopia, even without other focal signs, should raise suspicion for this condition 1.