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Diagnosis and treatment of deep cerebral vein thrombosis
F Erbguth1, P Brenner, G Schuierer
1Department of Neurology, University Hospital, Erlangen, Fed. Rep. of Germany.
Insights
Deep cerebral vein thrombosis can cause neurological deficits and impaired consciousness. Prompt heparin treatment, even with hemorrhage, led to good recovery in three patients, suggesting its efficacy.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Deep cerebral vein thrombosis is a rare condition.
- It can present with non-specific symptoms followed by focal neurological deficits and impaired consciousness.
Observation:
- Three cases presented with focal neurological deficits and impaired consciousness.
- Computed tomography revealed bilateral hemorrhagic infarctions of the thalamus and basal ganglia.
- Cerebrospinal fluid analysis showed pleocytosis, increased protein, and disturbed blood-brain barrier.
Findings:
- Diagnosis was confirmed by transfemoral carotid angiography and MRI showing internal venous system thrombosis.
- All patients received high-dose heparin treatment despite the presence of hemorrhage.
- Complete neurological recovery was observed in all patients without complications.
Implications:
- Bilateral thalamic lesions should raise suspicion for deep cerebral vein thrombosis.
- Early diagnosis and heparin treatment can lead to favorable outcomes.
- This case series highlights the potential of aggressive anticoagulation in deep cerebral vein thrombosis.
Abstract:
Three cases of deep cerebral vein thrombosis are reported. In all three cases focal neurological deficits and impaired consciousness occurred after a short period of non-specific clinical manifestations. Computed tomography revealed bilateral hemorrhagic infarctions of thalamus and basal ganglia. The CSF analysis which was performed in two cases showed pleocytosis, increased protein level, disturbed blood-brain barrier, and signs of necrosis and hemorrhage. In two cases the diagnosis was confirmed by transfemoral carotid angiography. MRI was performed in one case only and showed thrombosis of the internal venous system. All patients were treated with high-dose heparine in spite of hemorrhage. Good recovery was seen in all patients with almost complete improvement of neurological deficits. No complications were observed during treatment. Because of these promising therapeutic results, bilateral thalamic lesions should alert the physician to consider the possibility of deep cerebral vein thrombosis.