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The aim of this study was to assess the presence of an occipital sinus in both children and adults, and to detail its main associated anatomical characteristics.One hundred of patients' MRI (3D T1 EG) between 0 and 86 years old were studied, in sagittal and axial sections, with the software DxMM. Occipital sinus length, perimeter, and cerebellar falx length measurements were performed with the software's tools.Forty-three percent of patients had an occipital sinus (average perimeter was 3.02 mm, average length was 19.85 mm), and 23.26% of these patients had a cerebellar falx, 30.23% of these patients had one vein or more draining into the occipital sinus. Sixty-two percent of children had an occipital sinus (average perimeter was 2.87 mm, average length was 21.63 mm), and 29.03% of them had a cerebellar falx. Twenty-four percent of adults had an occipital sinus (average perimeter was 3.4mm, average length was 15.28 mm), and 8.33% of them had a cerebellar falx.This work highlights a link between the age and the occipital sinus existence. The perimeter of this sinus seems to be superior for adults, but its length seems to be superior for children. A cerebellar falx with the occipital sinus was found more frequently for children.

Cerebral venous thrombosis represents less than 1 % of all strokes, usually affecting young women, probably because of hormonal factors. The most common symptom is headache, with or without focal neurological findings such as deficits or seizures. Brain MRI is the gold standard for diagnosis. Anticoagulation should be initiated as soon as possible, followed by vitamin K antagonists, for at least 3 months. Predisposing causes and risk factors for cerebral venous thrombosis are multiple. Prognosis is good and recurrence rate is low.

The pathogenesis and treatment paradigm for idiopathic intracranial hypertension (IIH) are controversial. Transverse sinus stenosis is seen in the majority of patients with IIH and appears to play a role in the disease process. The debate continues as to whether transverse sinus stenosis is a primary or secondary process relative to raised intracranial pressure. While the role of transverse sinus stenosis in IIH pathogenesis remains controversial, modeling studies suggest that stent placement within a transverse sinus stenosis with a significant pressure gradient should decrease cerebral venous pressure, improve CSF resorption in the venous system, and thereby reduce intracranial (CSF) pressure, improving the symptoms of IIH and reducing papilledema. Beside the classical surgical treatments, venous sinus stenting could be a treatment option for many patients with IIH. However, additional work, preferably controlled prospective studies, needs to be performed to prove its safety and efficacy. The goal of this article is to review the current literature on dural venous sinus stenting.

Neurological manifestations of systemic lupus erythematosus are frequent and polymorphic. In 40% of cases, lupus can be revealed by neurological symptoms. Cerebral nervous system complications predominate and can be a negative factor for prognosis. Peripheral features are rare and various and can compromise functional prognosis, sometimes with fatal outcome.We report the case of a 30-year-old woman who presented a cerebral venous thrombosis of the superior longitudinal sinus. Outcome was favorable with antibiotics and anticoagulants. Four months later, she developed an acute polyradiculoneuritis associated with an inflammatory syndrome and positive tests for antinuclear antibody and antinuclear anti-DNA. The diagnosis of neurolupus was retained on the basis of four criteria of the American college of Rheumatology. The patient was given steroid therapy associated with a course of intravenous immunoglobulin. She has fully recovered her deficit.Cerebral venous thrombosis and acute polyradiculonévrites are rare events in systemic lupus erythematosus. Early diagnosis and management are crucial.

We report two cases of superior semicircular canal dehiscence related to a dehiscence of the superior petrous sinus that creates a localized notch of the most superior part of the superior semicircular canal. This vascular dehiscence was suspected at CT and was confirmed by MR imaging with identification of the superior petrous sinus in touch with the intralabyrinthine fluid at this level. This not well-known etiology of the superior semicircular canal dehiscence syndrome has to be searched and described by radiologists, allowing an optimal surgical approach.

This is a case report of successful arterial embolization of a dural fistula using absolute alcohol. In this two-part embolization of a dural fistula of the left sagittal venous sinus, the use of n-BCA (n-butyl-cyanoacrylate) was followed by 1 ml of absolute alcohol four months later. The first procedure, using n-BCA via the external carotid, permitted exclusion of the arterial supply coming from the medial meningeal and occipital arteries. Persistence of the blood supply through the internal carotid prompted us to perform the second procedure, to occlude the tentorium marginalis artery, using 1 ml of 95% ethanol. This was followed by a cranial nerve (III) palsy that was reversible. The three-month follow-up was satisfactory, although arteriography after one year showed revascularization of the fistula, which was successfully treated by Onyx. Routinely used in the treatment of superficial vascular malformations, the use of absolute alcohol intracerebrally appears to be unreliable, with results that were only temporary.

The cerebral venous system is poorly known and is best appreciated based on macroscopic anatomical considerations. We present an anatomical and immunohistochemical study to better define the morphological characteristics of the junction between the inferior cortical veins and the transversal sinuses.Sixteen cadaveric specimens from the anatomy laboratory of the University Victor-Segalen of Bordeaux were studied. The venous junctions with the transversal sinuses were observed under the operating microscope. Thirty vein-sinus junctions were immunohistochemically stained with smooth muscle actin. Ten venous junctions were observed under the electronic microscope.The inferior cortical veins drain into the transverse sinus either directly or through a tentorial sinus. The venous orifices in the transverse sinuses share the same characteristics. They are oval with semicircular superior dural reinforcement and follow an orientation opposite venous flow in the transversal sinus. The histologic study showed that the walls of the cortical veins contained smooth muscle cells as well as the dural reinforcement of the transversal sinuses.The venous orifices of the inferior cortical veins have the anatomical features of true sphincters. Their function in the regulation of the cerebral blood flow needs further exploration.

The purpose of this article is to give an overview of the cerebral and spinal cord pediatric malformations; we particularly describe three of them: Vein of Galen arteriovenous Malformation, Pial Arteriovenous Malformation, and Dural Sinus Malformation. We report the experience of Bicêtre since 1981 to 2003, with 317 VGAM, 302 Pial AVM and 30 DSM. We describe natural history, clinical and imaging features, endovascular management and the clinical and morphologic results. The clinical consequences of the VGAM and Pial AVM are systemic or cerebral. When they are cerebral they are mainly from hydrovenous type, as melting brain, or chronic hydrocephalus with calcifications and seizures. Depending of their angioarchitecture and amount of arteriovenous shunt, their gravity and the time of revealing are variable. Pial AVM, they carry the risk of hemorrhage, unlike VGAM. The presence of a fistula type should lead to suspect hereditary hemorrhagic telangiectasia. The main risk of DSM is hemorrhage due to thrombosis of the malformation, more than hydrovenous disorders. In VGAM, we obtain the complete cure of the shunt in 55% of case, and reduction of more than half of the shunt in 93.8%. Seventy-four percent of treated cases had a normal neurologic examination. DSM have a worse prognostic, and mortality is 38% despite treatment.

To describe the retrolabyrinthine approach for the resection of 9 meningiomas inserted around the lateral sinus between the transverse and sigmoid parts, to discuss the value of this approach compared to the retrosigmoid approach for resection of meningioma in this localization and to review the literature.Retrospective study. Between 1988 and 2002, 9 patients (8 female, mean age 50 years) underwent surgery via the retrolabyrinthine approach for resection of meningiomas inserted around the lateral sinus between the transverse and sigmoid parts.Resection was total (8 Simpson I and 1 Simpson II) in all patients. In the early postoperative course, one patient was treated for meningitidis with an LCR leak and one patient present a temporary paresis of the vagus nerve. Mean follow-up was 5 years (6 months-10 years). All patients continued their pre-treatment occupation after surgery. No recurrence was observed.Two approaches can be used for resection of meningiomas in this localization. The retrosigmoid approach is a common neurosurgical approach exposure of the cerobellopontine angle. It is practised by most neurosurgeons. Via this approach, the cerebellar lobe must be pushed back so the arteries feeding the tumor are in the operative field at the end of the procedure. For numerous authors the operative field is too narrow. On the other hand, the retrolabyrinthine approach described in 1972 by Hitselberger and Pulec allows exposure of feeding arteries during the first steps of operation, an easier resection of meningioma insertion and better control of the lateral sinus. This approach can be enlarged to the retrosigmoid or the subtemporal anatomic region.

Optic nerve sheath fenestration or ventricular shunting are classically proposed after failure of medical treatment. Idiopathic intracranial hypertension is caused by venous sinus obstruction in an unknown percentage of cases. Recently, endoluminal venous sinus stenting was proposed as an alternative treatment.Between September 2003 and December 2004, eight consecutive patients with a diagnosis of idiopathic intracranial hypertension underwent MRI venography and direct retrograde cerebral angiography.There were five females and three males aged 22 to 55 years. All patients had vision disorders. The cerebrospinal fluid pressure ranged from 27 to 45 mmHg with normal composition. All patients presented at least one sinus stenosis. Endovascular stenting of the stenotic venous sinus was performed under intravenous heparin administration. Anti-platelet therapy was administered for 3 months post treatment. Intra-sinus pressures were invariably reduced by stenting. Mean follow-up was 18 months. All patients improved clinically. The cerebrospinal fluid pressure had normalized at 3-month follow-up in all patients. In all patients, multidetector row CT-angiography or MRI venography was performed at 3-, 6- and 12-month follow-up and demonstrated the patency of the stent.The importance of venous sinus disease as a cause of idiopathic intracranial hypertension is probably underestimated. Patients with idiopathic intracranial hypertension should be evaluated with direct retrograde cerebral venography and manometry. In patients with venous sinus lesions, treatment by an endoluminal venous sinus stent is a safe and effective alternative for amenable lesions.

We report a case of benign intracranial hypertension in a 31-year-old man treated by endovascular stent placement in the right transverse sinus. The patient presented with a typical benign intracranial hypertension syndrome. Ophthalmologic findings showed bilateral papilledema with a 7/10 loss visual acuity loss in the right eye and 2/10 in the left eye. At lumbar puncture, cerebrospinal fluid (CSF) pressure was 40 mmHg. Magnetic resonance imaging (MRI) showed slit ventricles and dilatation of optic nerve sheaths. optiques. After failure of medical treatment, the patient was referred to our neurosurgical department for therapeutic decision. Direct retrograde cerebral venography showed predominant cerebral venous drainage via the right transverse sinus which exhibited stenosis in its proximal third. Mamometry revealed a 25 mmHg pressure gradient across the point of stenosis. Due to possible venogenic benign intracranial hypertension, endovascular stent placement was proposed and accepted by the patient. At 3 months follow-up, the patient was symptoms free, papilledema had disappeared and visual acuity was 10/10 on both eyes. CSF pressure on lumbar puncture was 11 mmHg. The pathophysiological aspects and therapeutic management of this pathology illustrated by this are discussed along with a careful and exhaustive review of the literature.

A better understanding of the significance of diffuse hyperdensity affecting the circle of Willis and the dural sinuses on unenhanced CT.We performed a retrospective study of 19 patients with a neurological manifestation and a CT scan without contrast injection. Among these 19 patients, six had been included because of primary or secondary polycythemia. The analysis of cerebral CT scans was made qualitatively by visual inspection and quantitatively.In patients with a hematocrit percentage exceeding 60%, both circle of Willis and dural sinuses were dense on unenhanced CT scans. A linear relation between the hemoglobin level and the contrast of the dural sinuses compared with the grey matter was observed with an excellent correlation (r = 0.934; n0.0001; p = 19).Increased density of cerebral vessels on unenhanced CT is a sign of a high hemoglobin level.

The case of a young female with an acute idiopathic low cerebrospinal fluid pressure is presented. Clinical-imaging manifestations were typical and two consecutive blood patches resulted in a complete and durable resolution of the symptomatology. We present a review of the various investigation and therapeutic techniques.

Temporal bone venous prolapse with or without meningeal prolapse are a frequent problem in middle ear and labyrinth surgery. 178 translabyrinthine approaches with prolapse study are reported in this retrospective study. Superficially, the approach was narrow in 43% of the patients because of a lateral sinus prolapse in 27 cases or a temporal meningeal prolapse in 50 patients. Surgery was technically difficult in 8 patients with lateral sinus prolapse associated with meningeal prolapse. Deep labyrinth structure reaming was difficult in 40% because of an abnormal position of the jugular bulb and/or the superior petrosal sinus. Both superficial and deep approach was narrow in 22% of the cases. 23 lateral sinus prolapses associated with transhigh jugular bulb and 17 lateral sinus prolapses associated with superior petrosal sinus prolapses were noted and reported. Expectation of these anatomical variations, more frequent on the right side, should be established before surgery with imaging studies in order to perform a safe and efficient surgical procedure.

Magnetic resonance angiography is now a technique commonly used in neurologic practice. We give a brief overview of the biophysical principles of this technique. Recent refinements and technical innovations are also noted. After some anatomic considerations about the carotid artery, we provide some data about the role of MRA in atherosclerotic and non atherosclerotic diseases (dissections, aneurysms, arteritis, post operative follow-up...) of the extra and intracranial carotid arteries. The purpose of this review is to concentrate on the role of magnetic resonance angiography in patients with various carotid artery diseases and to specify possibilities, limitations and risk of misinterpretation. Magnetic resonance angiography is a major, still evolving technique.

Kallmann syndrome is a disease clinically characterized by the association of hypogonadotrophic hypogonadism and anosmia or hyposmia. Most cases have been recorded among men. It is a genetic disorder with a specific gene location on the X chromosome. The cells that normally express luteinizing hormone-releasing hormone or LHRH fail to migrate the olfactory placode to the forebrain. The lateral projections of the olfactory placode also fail to induce development of the olfactory bulbs and tracts.The aim of this study was to compare the MRI appearance of the olfactory sulci, the olfactory bulbs and frontal lobe between groups. The first reference group was composed of 20 subjects and the second group of 18 patients suffering from Kallmann syndrome. For all studies we used a 1.5 T magnet system (Signa GE). We performed two sagittal and coronal T1-weighted sequences in spin echo (TR = 600 ms, TE = 12 ms) with interleaved 3 mm slices and a 14 cm field of view.In the first group, the two olfactory bulbs were always seen on coronal slices just behind the crista galli measuring 2 to 3.2 mm transversally. On sagittal slices, in 60% of the cases two bulbs were seen (3 mm laterally of the pituitary stalk) and in the other 40% only one bulb was seen. The length of the bulb has been measured between 6 and 11 mm. We noticed a plat frontal lobe in 85% of the cases. In the second group the olfactory bulbs were never visible among the 18 patients suffering from Kallmann syndrome. The hypoplasic sulci were hardly visible and their size was less or equal to 1 cm and the frontal lobe was triangular in 80% of the cases. One patient had hypoplasia of corpus callosum.MRI is helpful tool to demonstrate abnormalities of the olfactory system which are always present among patients suffering from Kallmann syndrome. MRI can also show, at the same time, a possible associated brain abnormality.

We report a case in which MRA made it possible to diagnose a dural arteriovenous fistula and thrombophlebitis in a 23-year old woman. 2D TOF MRA is the usual technique in the diagnosis of thrombophlebitis. Our experience shows the limits of 2D TOF since the increased signal intensity in the sinus could simulate a normal flow, and we describe the advantages of MR subtraction angiography. In our study, 3D TOF MRA showed the dural arteriovenous fistula, its location near the right transverse sinus and some of the feeding vessels: tentorial branch of the internal carotid artery and meningeal branch of the right occipital artery. 3D TOF MRA provides the diagnosis of dural arteriovenous fistula, but it cannot replace the plain angiography performed before endovascular or surgical treatment.

A case of lateral sinus thrombosis which occurred after mastoiditis in an 8 year old girl is reported. The elements of clinical diagnosis, the contribution of medical imaging and the medical and surgical management of this scarce but potentially severe affection are discussed.

The venous return of the cerebral hemispheres is ensured by two systems. The first, superficial system, reaches the peripheral dural sinuses, i.e. the superior sagittal sinus, the lateral sinus and the cavernous sinus. The second, deep system, corresponds to Galen's vein. Anatomical and angiographic data from the literature enable the usual drainage territory to be defined for each of these collecting vessels. However, the variability of the superficial sylvian vein and the importance of cortical anastomotic vessels make impossible to delimit precisely the territory of each peripheral sinus. The functional role played by numerous centro-peripheral anastomoses is more difficult to assert in each individual. It is therefore probable that in the cerebral hemispheres there is a deep territory balancing the superficial territories.

Dural arteriovenous fistula and sinus thrombosis are sometimes associated. The relationship between these two conditions remains unclear. Thrombophlebitis of the dural sinus may induce a dural fistula. Conversely, thrombophlebitis is sometimes observed in the course of dural fistulas. We report five cases of dural arteriovenous fistulas associated with sinus thrombosis. In three cases, the angiographic and pathological data indicated the responsibility of thrombosis in the occurrence of the fistula. In the others two cases, thrombophlebitis and fistula were simultaneously diagnosed by angiography. However, in one of these cases, the clinical data showed that the fistula probably was a causative factor in the occurrence of thrombophlebitis.

A 21-year-old male of Moroccan descent was admitted for inflammatory polyarthralgia and monoarthritis of the left knee. The patient reported a history of recurrent isolated aphthous ulcerations of the oral cavity. He was found to be positive for the HLA B5 antigen. The other investigations for Behçet's disease were negative. During hospitalization, headache responsible for insomnia developed. Neurologic evaluation was normal, as well as funduscopy and spinal tap findings. CT scan images were suggestive of cerebral thrombophlebitis. Magnetic resonance imaging (MRI) disclosed an old thrombosis of the right transverse sinus. Time-of-flight MRI (MRI with sequences adapted to the study of vessels) evidenced recent thrombophlebitis of the left transverse sinus. Cerebral angiography fully confirmed MRI findings. Treatment with a corticosteroid and an anticoagulant was successful. Final diagnosis was Behçet's disease. Subsequently, the patient developed additional features of the disease, including hypersensitivity to pinprick, retinal vasculitis, and erythema nodosum. This case is interesting for two reasons: cerebral thrombophlebitis in Behçet's disease can manifest as localized headache. It occurs in 6 to 13% of patients. Early diagnosis and treatment are essential; MRI features of cerebral thrombophlebitis were confirmed by the cerebral angiogram. MRI established that the thrombophlebitis was of recent onset. MRI may be appropriate as the initial investigation in patients with suspected cerebral thrombophlebitis.

Objective pulsatile tinnitus is an unusual disease. Diagnosis, suspected by the interrogation, can be confirmed by vascular radiography. Treatments are discussed and can use surgical solution or interventional radiology. The authors describe one case of arteriovenous occipito-sinusal fistula revealed by pulsatile tinnitus and treated with success by means of embolisation.

Selective catheterization of the inferior petrosal sinus has been performed in 23 patients: 11 Cushing's disease, 5 lung carcinoid tumors whose diagnosis has been confirmed by surgery and 7 ACTH-dependent hypercortisolism whose final diagnosis has not yet been proved. The pituitary origin of hormone secretion is accepted if the central-to-peripheral ratio (C/PR) is equal or greater than 2 on basal values and/or during CRF test. On basal values, all subjects but one with confirmed pituitary lesions exhibited a C/PRor = 2; the carcinoid tumors never exceeded the value of 1.3. After CRF injection, all the pituitary tumors showed an increase in C/PR; one patient with a lung carcinoid tumor (CRF-negative) showed a pituitary ACTH secretion (C/PR = 3.7). The localization of pituitary adenoma by the lateralization of hormone secretion is disappointing, except, perhaps, for very small extremely lateral adenomas. No accident occurred in our series, nor in the literature. This investigation seems the most reliable approach to prove the pituitary origin of hormonal hypersecretion. We recommend it to be performed in ACTH-dependent Cushing's syndrome when the secretory pattern is not typical and/or pituitary imaging is normal.

A 17 year-old man with a one-year history of Crohn's disease presented with superior sagittal sinus thrombosis in spite of an apparent remission of the inflammatory bowel disease. Under treatment, the neurological disorders rapidly improved. Hematological studies showed mild thrombocytosis, spontaneous platelet aggregation, and an increase of the fibrinogen level, plasmatic viscosity and red blood cells aggregability. Mild hypofibrinolysis and antiphospholipid antibodies were also noted. Nine fully documented cases of cerebral venous thrombosis associated with an inflammatory bowel disease are reviewed. The possible prothrombotic role of thrombocytosis and other hematological disorders is discussed.

A 33-year old man developed progressive intracranial hypertension with papilloedema due to thrombosis of the superior sagittal sinus (SSS) by extension of a skull osteitis. Serological tests for syphilis were positive in blood, CSF and synovial fluid. Under treatment with penicillin and corticosteroids signs of intracranial hypertension and CT scan abnormalities disappeared. SSS thrombosis persisted at angiographic control.

On the basis of two recent cases of dural fistula of the lateral sinus, the authors review the literature relating to this type of arteriovenous fistulae. The development of selective arteriographic techniques has allowed better knowing them, ensurgin the diagnosis and also treating them with embolization techniques. The role of the ENT specialist is no less important: during the clinical stage, it for him to recognize the pulsatile character of a tinnitus and to demonstrate it in order to establish the diagnosis.

The Authors conceive the petrous bone as made of four segments bounded by two vertical plans, one passing through the anterior wall of the internal auditory canal and the posterior wall of the external auditory canal, the other passing through the inner aspect of the tympanic cavity and the outer aspect of the labyrinthe. Drilling away one or several segments realizes a trans-petrous approach which always begins by drilling away the posterior-external segment, the retro-labyrinthine segment. Drilling away only the retro-labyrinthine segment realizes retro-labyrinthine approach which entirely put into sight the circumference of the bending of the lateral sinus. Thus, it is possible to perfectly and more easily deal with lesions localized in this region. The skin incision is made two fingerbreadths above and behind the external ear. The scalp uncovers the mastoid as far as the posterior ring of the external auditory canal. The superficial drilling uncovers the temporal dura, the lateral sinus and the occipital dura and between them the sinuso-dural angle. Then the mastoid is drilled away as far as the antrum is opened. Its aditus internally sided by the loop of the external semi-circular canal serves to localize the external surface of the labyrinthe. Finally, the retro-labyrinthine approach is bounded by the posterior wall of the external auditory canal anteriorly, by the external surface of the labyrinthe internally, by the dura of the superior surface of the petrous bone superiorly and by the bended part of the lateral sinus and the dura of the posterior surface of the petrous bone posteriorly. The closure is made with a dural graft then with bony dust mixed with biologic glue, then the petrectomy is plugged with under-skin fat and then the superficial planes are carefully stitched. The authors report 5 cases of meningiomas of the lateral sinus, 1 case of hemangiopericytoma and 2 dural arteriovenous fistulas which demonstrate the interest of this approach to lesions developed on this part of the lateral sinus.

A 35 year-old caucasian man suffered from paroxysmal nocturnal haemoglobinuria (PNH) or Marchiafava-Micheli's disease diagnosed in 1976 and complicated by several thrombotic episodes. He developed a benign intracranial hypertension. A digitalized intravenous angiography showed occlusion of both lateral sinuses. Partial improvement followed lombo-peritoneal shunting and steroid therapy. Cerebral venous thrombosis is a well-known complication of PNH but only a few cases have been radiologically and/or pathologically proven. It usually involves the superior longitudinal sinus and/or cortical veins resulting in hemorrhagic infarction of poor outcome. Benign intracranial hypertension due to a venous occlusion is rare. In 3 published cases, as in our own, the neurologic outcome was good. Steroid therapy seems useful. The risks of anticoagulant therapy are discussed.

Neurosurgeons are confronted with the superior longitudinal sinus (SLS) in three circumstances: following injuries; compression or invasion of the sinus by tumors, particularly parasagittal meningiomas; and other less common occasions such as measuring pressure in the SLS or in the presence of a ventriculosinusal shunt or phlebitis of the SLS. Anatomical and physiological features of the sinus can be summarized as follows. The emissary veins open directory into the sinus at different angles according to whether they are anteriorly, medially, or posteriorly located. Their orifices are protected by willis cords, provoking laminar flow in the sinus. Pacchionian bodies are found mainly in the parasinusal blood lakes. To ensure an effective cerebral blood flow, pressure in the sinus must be less than that of the cerebrospinal fluid which itself must be at a lower pressure than that in the cortical veins. The anatomical structure of the sinuses in the rigid dural folds explains why they are compressed little or not at all by increased intracranial pressure. Surgery on the sinus should therefore include conservation or re-establishment of its two fold structure; internal venous, perfectly visible under the operating microscope, and external dura mater structure. Based on these anatomophysiological considerations, experimental sinus surgery was performed in the dog: either replacement of one or two sinus walls by a venous autograft doubled with dura mater. These techniques have been employed in humans mainly for parasagittal meningiomas, but they can be used for sinus injuries. A provisional shunt is necessary only when there is cerebral edema with venous turgescence, particularly posterior to the rolandic veins. Suturing of wounds, or their repair by means of a vein graft is employed whether they are associated or not with hematomas. Sinus invasion of meningiomas is diagnosed from the venous time of bilateral carotid angiography employing the subtraction process.

The case reported here is the first observation of thrombophlebitis of the superior sagittal and left transverse sinuses in a patient with systemic lupus erythematosus. Thrombophlebitis occurred thirty-six years after onset of SLE. The patient had neither nephrotic syndrome nor serum anti-coagulants. Various hypotheses concerning pathogenesis are suggested. The opportunity for heparin therapy is discussed.