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[Cerebral deep vein thrombosis: three cases]
C Di Roio1, C Jourdan, H Yilmaz
1Département d'Anesthésie-Réanimation, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Lyon.
Insights
Cerebral venous sinus thrombosis is a rare condition in adult males, often presenting with severe neurological symptoms. Despite intensive care, all reported cases were fatal, highlighting diagnostic and therapeutic challenges.
Area of Science:
- Neurology
- Vascular Medicine
Background:
- Cerebral venous sinus thrombosis (CVST) is an uncommon cause of stroke.
- Diagnosis can be challenging, particularly in non-traditional presentations.
Observation:
- Three adult male cases of cerebral internal venous thrombosis are presented.
- Clinical manifestations included headaches, vomiting, dizziness, coma, intracranial hypertension, and cardiocirculatory arrest.
- Diagnostic imaging (CT scan, cerebral angiography) confirmed thrombosis, revealing hemorrhagic/ischemic lesions, cerebral edema, and hydrocephalus.
Findings:
- No patient survived despite comprehensive intensive care, including anticoagulation, CSF drainage, osmotherapy, and mechanical ventilation.
- Pre-existing conditions like sickle cell disease, radiotherapy for pineal tumors, or suspected autoimmune disease were noted in two and three cases, respectively.
- The rarity and diagnostic difficulty of CVST are emphasized.
Implications:
- This case series underscores the poor prognosis of cerebral internal venous thrombosis.
- It highlights the need for increased awareness and timely diagnosis of CVST.
- Further research into optimal treatment strategies for this rare condition is warranted.
Abstract:
Cerebral internal venous thrombosis are rare and diagnosis is difficult. We report three cases in male adults. Clinical data were headaches, vomiting, dizziness and coma, in relation with an intracranial hypertension, or in a case, cardiocirculatory arrest. Cerebral internal veinous thrombosis was diagnosed by a CT scan and cerebral angiography twenty four hours after the admission in neurosurgical intensive care. CT scan showed hemorrhagic and ischemic lesions of thalami in two cases, diffuse cerebral edema in two patients, early or delayed hydrocephaly in two cases. No patient survived despite intensive treatment including heparinotherapy, ventricular CSF drainage, osmotherapy, dehydration, barbiturate, other antiepileptic drugs and mechanical ventilation. In two cases, general or local illness was found, sickle cell disease or radiotherapy for pineal tumor, and in case 3 clinical signs evoked autoimmune disease, not demonstrated by biological samples.