Deep Cerebral Venous Thrombosis—A Clinicoradiological Study

Stroke is a common neurological emergency. Almost 80% of strokes are due to arterial occlusion. Venous thrombosis comprises less than 1–2% of all strokes. Involvement of the deep cerebral venous system is still rare and accounts for about 10.9% of all cerebral venous thromboses (CVT). CVT diagnosis is often delayed or missed, because of its variable clinical manifestations. We retrospectively (2015–18) and prospectively (2018–20) reviewed all the cases of CVT in a tertiary care center in south India. Out of a total of 52 CVT cases, 12 were due to the involvement of deep cerebral venous system. Their clinical presentation, imaging characteristics, and outcomes were assessed. The most frequent presentation was headache followed by seizures. Hyperhomocysteinemia was the most common risk factor noted. Imaging characteristics were variable, and a high index of suspicion was required for early diagnosis. All patients had favorable outcome in our study, and except one, all were treated conservatively.

Isolated deep cerebral venous thrombosis

Deep cerebral venous thrombosis is a rare pathology and hard to diagnose cause of the acute cerebrovascular diseases. Commonly, the veins of Galen and Rosenthal affected by the non-isolated deep cerebral venous thrombosis are described in most of the publications. The article presents a clinical case of an extremely rare isolated deep cerebral venous thrombosis in a female patient aged 31 years with a burdened obstetric history and thrombophilia. The disease onset started with increasing hypertension headache, congestive changes in the fundus, cerebellar and pyramidal signs. Magnetic resonance imaging (MRI) of the brain revealed a pattern of a multi-focal brain lesion. Thus, the primary diagnosis of «multiple sclerosis» was established, so the patient received pulse therapy. Differential diagnosis was conducted with systemic connective tissue diseases. Regression of headaches, of changes in the fundus, dynamic neuroimaging data, and the results of hematology test made it possible to diagnose «deep cerebral venous thrombosis». During the anticoagulant therapy, there was a positive dynamics: the foci significantly regressed according to MRI data, the patient became pregnant and delivered a healthy child. The article describes the characteristics of MRI images on deep cerebral venous thrombosis, which can be used to diagnose this patholo gy. KEYWORDS: deep cerebral venous thrombosis, сerebral venous sinus thrombosis, thrombophilia, coagulopathy, infertility, headache, multiple sclerosis. FOR CITATION: Matveeva T.V., Ibatullin M.M., Gaifutdinov R.T. et al. Isolated deep cerebral venous thrombosis. Russian Medical Inquiry. 2020;4(9):595–600. DOI: 10.32364/2587-6821-2020-4-9-595-600.

Unilateral Thalamic Venous Infarction in an Infant: A Rare Presentation of Bilateral Deep Cerebral Venous Thrombosis

Cerebral venous thrombosis (CVT) may manifest as superficial cerebral venous thrombosis (SCVT) or deep cerebral venous thrombosis (DCVT). Of the two patterns, DCVT is less commonly observed, although it often results in greater morbidity and mortality due to involvement of the deep gray nuclei. It can present at any age and typically results in edema of the bilateral thalami, with occasional extension into the basal ganglia. Unilateral thalamic infarct is rare and results in an ambiguous imaging pattern. We present the clinical and neuroimaging profile of an acute unilateral thalamic venous infarct in an infant secondary to bilateral DCVT. Early recognition of this atypical pattern will facilitate accurate diagnosis and treatment, and obviate the need for unnecessary interventions.