Acute cerebral vein and dural sinus thrombosis are usually treated with unfractionated intravenous heparin. Progression of symptoms after appropriate heparin dosage appears to be a rare event. In the literature only single case reports or small case series dealing with local intravenous fibrinolysis are available. Here we describe a 44-year-old woman with progressive thrombosis of the sinus rectus and right sinus transversus upon an appropriate dosage of heparin who was successfully treated with urokinase 12 h after symptom onset. This case demonstrates that local thrombolysis should be discussed in patients with progression of the clinical or radiological picture under sufficient heparin therapy.