What is the management of sagittal sinus thrombosis?

What is the management of sagittal sinus thrombosis?

 

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.