Headache & Pain
Medication overuse headache
Aug. 28, 2023
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Sagittal T1-weighted MR image of a 22-year-old woman from 1988 shows a normal sagittal sinus (A), whereas MR image from 1992 shows a clot within the sagittal sinus. Patient had marked and progressive increase in intracranial pressure with loss of vision, despite heparin therapy, and was subsequently treated with multiple doses of intravenous tissue plasminogen activator. Patient's condition and thrombus formation stabilized, but the thrombus did not resolve despite thrombolytic therapy. Optic nerve fenestrations and finally a lumbar-peritoneal shunt successfully relieved symptoms of increased intracranial pressure. (Used with permission. JP Broderick. Cerebral venous thrombosis. In: Feldman E, editor. Current diagnosis in neurology. St. Louis: Mosby, 1994.)