Superior sagittal sinus thrombosis due to lithium: Local urokinase thrombolysis treatment

Abstract

Superior sagittal sinus thrombosis (SSST) is associated with a host of predisposing factors, including pregnancy, collagen vascular disease, malignancy, diabetes insipidus, and medications such as oral contraceptive agents, l-asparaginase, androgens, and heparin.1 The diagnosis of cerebral venous thrombosis may be challenging,2 so it is important to recognize underlying causes. We report a young woman with SSST associated with lithium-induced nephrogenic diabetes insipidus. This is the first reported case of venous sinus thrombosis secondary to lithium therapy. The patient was treated successfully with local urokinase thrombolysis. A 30-year-old woman with a history of bipolar disorder presented with progressive headache, confusion, visual blurring, and left hemiparesis. She had been taking lithium, risperidone, and oral contraceptive agents for many years. Neurologic examination showed confusion, papilledema, and mild left hemiparesis. Urine output was markedly elevated (greater than 200 mL/hour). Significant laboratory abnormalities included serum platelet count 106,000/mm3, sodium …