Superior Sagittal Sinus Thrombosis-Reply

In Reply.—  The patients reported by Drs Castaigne, Laplane, and Bousser are interesting and serve to underscore the dilemma in therapy of cerebrovascular disease, that being the unavailability of satisfactory controlled studies assessing the efficacies of various therapeutic modalities.¹ When such studies are unavailable for arterial occlusive disease, which is much more common, it is not surprising that none exists for venous disease, nor do we expect that one will be forthcoming.In our series, we specifically excluded those patients with intracranial neoplasm or infection, thus the patients of Dr Castaigne and associates are not strictly comparable. However, this does not resolve the problem that some patients do well and others poorly with apparently similar treatment.Heparin is commonly believed to discourage the development and propagation of thrombus, but has no known thrombolytic activity. Thus, while heparin might be expected to arrest progression of neurologic symptoms, it is not obvious how