J Cerebrovasc Endovasc Neurosurg.  2012 Sep;14(3):233-236. 10.7461/jcen.2012.14.3.233.

Unilateral Thrombosis of a Deep Cerebral Vein Associated with Transient Unilateral Thalamic Edema

• Chung SW
• Hwang SN
• Min BK
• Kwon JT
• Nam TK
• Lee BH

• KMID: 1808461
• DOI: http://doi.org/10.7461/jcen.2012.14.3.233

Abstract

Symptoms of deep cerebral vein thrombosis (DCVT) are variable and nonspecific. Radiologic findings are essential for the diagnoses. In the majority of cases of deep internal cerebral venous thrombosis, the thalamus is affected bilaterally, and venous hypertension by thrombosis causes parenchymal edema or venous infarction and may sometimes cause venous hemorrhage. Intravenous injections of mannitol can be administered or decompressive craniectomy can be performed for reduction of intracranial pressure. The objectives of antithrombotic treatment in DCVT include recanalization of the sinus or vein, and prevention of propagation of the thrombus. Herein, the authors report DCVT which was successfully treated by low molecular weight heparin.

Keyword

Intracranial thrombosis; Venous thrombosis; Cerebral infarction; Brain edema

MeSH Terms

Brain Edema
Cerebral Infarction
Cerebral Veins
Decompressive Craniectomy
Edema
Hemorrhage
Heparin, Low-Molecular-Weight
Hypertension
Infarction
Injections, Intravenous
Intracranial Pressure
Intracranial Thrombosis
Mannitol
Thalamus
Thrombosis
Veins
Venous Thrombosis
Heparin, Low-Molecular-Weight
Mannitol

Figure

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  Fig. 1 Brain magnetic resonance images (MRI), computed tomography (CT) and digital subtraction angiography (DSA) obtained from a 36-year-old female patient with unilateral thrombosis of the left internal cerebral vein and thalamostriate vein. Initial T2 fluid attenuation inversion recovery (FLAIR) image shows normal finding in the thalamic area (A). Left thalamic edema is noted on a T2 FLAIR image obtained seven days after initial symptoms. The patient had dysarthria, hemiparesis, and a headache (B). Susceptibility weighted image (SWI) shows a diffuse susceptibility effect of thrombus in the left internal cerebral vein and thalamostriate vein (C). DSA shows occlusion in the left internal cerebral vein (D).

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  Fig. 2 After low molecular weight heparin therapy (60 mg subcutaneous injection, 120 mg per day), CT (A) and CT (B, C, D) angiography shows a recanalization in internal cerebral vein.

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  Fig. 3 Brain MRI 53 days after treatment. Susceptibility weighted image (SWI) shows resolved thrombus in the left internal cerebral vein and thalamostriate vein (A). T2 FLAIR image shows resolved left thalamic edema (B).

Reference

1. Ameri A, Bousser M. Cerebral venous thrombosis. Neurol Clin. 1992. 02. 10(1):87–111.

2. Bell D, Davis WL, Osborn A, Harnsberger HR. Bithalamic hyperintensity on T2-weighted MR: vascular causes and evaluation with MR angiography. AJNR Am J Neuroradiol. 1994. 05. 15(5):893–899.

3. Crawford SC, Digre KB, Palmer CA, Bell DA, Osborn AG. Thrombosis of the deep venous drainage of the brain in adults: analysis of seven cases with review of the literature. Arch Neurol. 1995. 11. 52(11):1101–1108.

4. de Bruijn SF, de Haan RJ, Stam J. Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. For The Cerebral Venous Sinus Thrombosis Study Group. J Neurol Neurosurg Psychiatry. 2001. 01. 70(1):105–108.

5. de Bruijn SF, Stam J, Kappelle LJ. CVST Study Group. Thunderclap headache as first symptom of cerebral venous sinus thrombosis. Lancet. 1996. 12. 348(9042):1623–1625.

6. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F. ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004. 03. 35(3):664–670.

7. Herrmann KA, Sporer B, Yousry TA. Thrombosis of the internal cerebral vein associated with transient unilateral thalamic edema: a case report and review of the literature. AJNR Am J Neuroradiol. 2004. 09. 25(8):1351–1355.

8. Isensee C, Reul J, Thron A. Magnetic resonance imaging of thrombosed dural sinuses. Stroke. 1994. 01. 25(1):29–34.

9. Kothare SV, Ebb DH, Rosenberger PB, Buonanno F, Schaefer PW, Krishnamoorthy KS. Acute confusion and mutism as a presentation of thalamic strokes secondary to deep cerebral venous thrombosis. J Child Neurol. 1998. 06. 13(6):300–303.

10. Pfefferkorn T, Crassard I, Linn J, Dichgans M, Boukobza M, Bousser MG. Clinical features, course and outcome in deep cerebral venous system thrombosis: an analysis of 32 cases. J Neurol. 2009. 11. 256(11):1839–1845.

11. Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Ferriero D, et al. Management of stroke in infants and children. Stroke. 2008. 09. 39(9):2644–2691.

12. Rousseaux M, Cabaret M, Bernati T, Pruvo JP, Steinling M. [Residual deficit of verbal recall after a left internal cerebral vein infarct]. Rev Neurol (Paris). 1998. 06. 154(5):401–407. French.

13. Sagduyu A, Sirin H, Mulayim S, Bademkiran F, Yunten N, Kitis O, et al. Cerebral cortical and deep venous thrombosis without sinus thrombosis: clinical MRI correlates. Acta Neurol Scand. 2006. 10. 114(4):254–260.

14. Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005. 04. 352(17):1791–1798.

15. Stefini R, Latronico N, Cornali C, Rasulo F, Bollati A. Emergent decompressive craniectomy in patients with fixed dilated pupils due to cerebral venous and dural sinus thrombosis: report of three cases. Neurosurgery. 1999. 09. 45(3):626–629. discussion 629-30.