The authors report about a patient with thrombosis of the transverse and sigmoid sinus who also suffered from multiple pulmonary embolism and deep leg vein thrombosis. The etiologic factor was a deficiency of the free (unbounded) and total protein S. The cerebral sinus thrombosis was diagnosed by MRI and angio-MRI. The first 4 weeks the patient was treated with heparin and later with phen-procoumon. The plasma protein S serves as a cofactor for protein C and plays an important role in the anticoagulation. Deficiencies of these proteins are either hereditary with an autosomal dominant trait or acquired in patients with severe hepatic diseases and coagulation disorders.
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