SUPERIOR SAGITTAL SINUS THROMBOSIS IN A PATIENT WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

A 41-year-old man with acquired immunodeficiency syndrome was admitted to the hospital because of a recent onset of disorientation and memor y loss. He developed focal neurologic signs on hospital day 4, and a c omputed tomographic scan of his head showed a right medial temporal lo be hyperdensity. Before diagnosis could be made or treatment started, the patient was unexpectedly found dead on hospital day 14. At autopsy , a primary central nervous system B-cell immunoblastic lymphoma was f ound involving both hippocampi and other periventricular areas. Associ ated angiodestruction and necrosis with local vascular thrombosis-were seen. In addition, there was extensive, partial thrombosis of the sup erior sagittal sinus and distal superficial cortical veins unassociate d with cerebral hemorrhage or infarction, lymphoma, or involvement wit h opportunistic organisms. Retrospective review of radiographic studie s demonstrated the classic ''empty delta'' sign. To our knowledge, cer ebral venous and dural sinus thrombosis has not been well documented i n patients with the acquired immunodeficiency syndrome. Because the du ral venous sinuses are not routinely examined at autopsy in many insti tutions, cerebral venous/dural sinus thrombosis in patients with the a cquired immunodeficiency syndrome may be more frequent than is present ly recognized.