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Deep cerebral venous thrombosis: an illustrative case with reversible diencephalic dysfunction
D J Gladstone1, F L Silver, R A Willinsky
1University of Toronto and the Royal College of Physicians and Surgeons of Canada Clinician-Investigator Program, Ontario.
Summary
Deep cerebral venous thrombosis (DCVT) is a rare condition that can be challenging to diagnose. This case highlights that early diagnosis and treatment can lead to excellent recovery, even with severe symptoms.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Isolated deep cerebral venous thrombosis (DCVT) is an uncommon neurological emergency.
- Diagnosis can be challenging, and long-term prognosis is often poorly understood.
- High mortality rates are associated with DCVT.
Observation:
- A 24-year-old woman presented with akinetic mutism and bilateral thalamic lesions.
- Computed tomography (CT) and magnetic resonance imaging (MRI) enabled early diagnosis of internal cerebral vein thrombosis.
- Heparin therapy was administered safely despite concurrent thalamic and intraventricular hemorrhage.
Findings:
- Neuroimaging revealed thrombosis within the internal cerebral veins, leading to extensive venous congestion and vasogenic edema.
- The patient experienced a rapid and complete clinical recovery within five weeks.
- Serial MRI demonstrated a dramatic resolution of the initial brain abnormalities.
Implications:
- Recognizing the clinical and neuroimaging features of DCVT is crucial for timely diagnosis in stroke patients.
- Prompt anticoagulation therapy can be effective and safe, even in the presence of hemorrhage.
- Excellent clinical outcomes are achievable following severe neurological deficits caused by DCVT.