Diabetes mellitus with left transverse sinus thrombosis and right transverse sinus aplasia

A 67-year-old woman with diabetes mellitus was hospitalized due to a throbb ing headache. She appeared neurologically normal, except for meningeal irri tation. The cerebrospinal fluid pressure was high. There was increased flui d protein without an increased cell count. Brain CT scan showed no abnormal ity, however, brain magnetic resonance angiography (MRA) showed complete ri ght transverse sinus stasis and partial left transverse sinus stasis, indic ating bilateral transverse sinus thrombosis. At this time thrombin anti-thr ombin III complex (TAT) and prothrombin fragment F1 + 2 (PTF1 + 2) indicati ng hypercoagulation had increased. Urokinase, followed by aspirin and ticlo pidine hydrochloride were administered. After diet therapy and transient in sulin administration, her blood glucose levels improved. By the 22nd day, t he headache had disappeared. Subsequently, brain MRA showed left transverse sinus blood flow recovery and complete right transverse sinus stasis, whil e carotid angiography showed recovered left transverse sinus but right tran sverse sinus defect. TAT and PTF1 + 2 levels improved concomitantly with be tter blood glucose control. We diagnosed this case as left transverse sinus thrombosis because of the hypercoagulable state resulting from diabetes me llitus accompanied by right transverse sinus aplasia. (C) 2001 Elsevier Sci ence Ireland Ltd. All rights reserved.