Superior sagittal sinus thrombosis in a patient with acquired immunodeficiency syndrome.

Abstract

A 41-year-old man with acquired immunodeficiency syndrome was admitted to the hospital because of a recent onset of disorientation and memory loss. He developed focal neurologic signs on hospital day 4, and a computed tomographic scan of his head showed a right medial temporal lobe 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 found involving both hippocampi and other periventricular areas. Associated angiodestruction and necrosis with local vascular thrombosis were seen. In addition, there was extensive, partial thrombosis of the superior sagittal sinus and distal superficial cortical veins unassociated with cerebral hemorrhage or infarction, lymphoma, or involvement with opportunistic organisms. Retrospective review of radiographic studies demonstrated the classic "empty delta" sign. To our knowledge, cerebral venous and dural sinus thrombosis has not been well documented in patients with the acquired immunodeficiency syndrome. Because the dural venous sinuses are not routinely examined at autopsy in many institutions, cerebral venous/dural sinus thrombosis in patients with the acquired immunodeficiency syndrome may be more frequent than is presently recognized.