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Department of Neurology, University of Massachusetts Medical Center, Worcester.
A 26-year-old woman had a peripartum venous thrombotic stroke involving the right parietal lobe. The initial thrombus was present only in the right channel of a congenitally bifurcated superior sagittal sinus. This diagnosis and subsequent thrombus extension were readily shown by magnetic resonance imaging in contrast to equivocal angiography. A subsequent, prospective review of 100 patients undergoing cranial magnetic resonance imaging showed the presence of similarly bifurcated superior sagittal sinuses in two. The patient stabilized after therapy with intravenous heparin, but switching her medication to oral warfarin sodium was followed by clinical deterioration and propagation of the thrombus, necessitating resumption of intravenous heparin. No coagulopathy was identified.
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