Bilateral thalamic stroke due to cerebral vein thrombosis: endovascular treatment, case report
PDF (Español)
XML (Español)

Keywords

Intracranial sinus thrombosis
intracranial thrombosis
thalamus
warfarin
heparin
thrombectomy (MeSH)

Abstract

Thrombosis of the dural sinus and/or cerebral veins (CVT) is a rare but potentially devastating type of stroke that tends to occur in young adults, especially women. CVT represents about 0.5% of all strokes and can be challenging to diagnose because headache, rather than focal neurologic symptoms, is the prominent feature. However, some patients (especially those with deep cerebral venous occlusion) may present with bilateral thalamic or basal infarction and often will have decreased level of consciousness and rapid neurologic deterioration. The diagnosis of CVT is confirmed with MRI and magnetic resonance venogram (MRV). The mainstay of acute management is anticoagulation. However, some patients do not respond to medical therapy and these might benefit from endovascular mechanical thrombectomy. We present the case of a 29 year old female patient with bilateral thalamic and gangliobasal ischemia secondary to CVT, who was treated with anticoagulation and endovascular mechanical thombectomy.

https://doi.org/10.22379/24224022168

PDF (Español)
XML (Español)

References

Stam J. Thrombois of the cerebral veins and sinuses. N Engl J Med. 2005;352(17):1791-8. http://dx.doi.org/10.1056/NEJMra042354

Saposnik G, Barinagarrementeria F, Brown RD JR, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis. A statement for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2011;42(4):1158-92. http://dx.doi.org/10.1161/STR.0b013e31820a8364

Bushnell C, Saposnik G. Evaluation and management of cerebral venous thrombosis. Continuum (Minneap Minn). 2014;20(2):335-51. http://dx.doi.org/10.1212/01.CON.0000446105.67173.a8

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;35(3):664-70. http://dx.doi.org/10.1161/01.STR.0000117571.76197.26

Bayona H. Trombosis Venosa Cerebral, enfermedad aún desconocida. Acta Neurol Colomb. 2012;28(2):67-69.

Bousser Mg, Ferro Jm. Cerebral Venous Thrombosis an update. Lancet Neurol. 2007;6(2): 162-70. http://dx.doi.org/10.1016/S1474-4422(07)70029-7

Guenther G, Arauz A. Trombosis venosa cerebral: aspectos actuales del diagnóstico y tratamiento. Neurologia. 2011;26(8):488-98. http://dx.doi.org/10.1016/j.nrl.2010.09.013

Amaya González P, Ramírez SF, Rodríguez JE. Trombosis venosa cerebral, descripción clínica de una serie de casos en adultos de Bogotá-Colombia. Acta Neurol Colomb. 2012;28(2):70-75.

Einhapul K, Stam J, Bousser Mg, De Brujin Sf, Ferro JM, Martinelli I, et al. EFNS Guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010;17(10):1229-35. http://dx.doi.org/10.1111/j.1468-1331.2010.03011.x

Pereira P, Martins de Carvalho G, Pereira-Gomes A. Cerebral venous sinus thrombosis: study of fifteen cases and literature review. Rev Assoc Med Bras. 2010;56:288-92. http://dx.doi.org/10.1590/S0104-42302010000300011

Bruijn Sf, Stam J, Koopman Mm, Vandenbroucke JP. Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in [correction of who are] carriers of hereditary prothrombotic conditions. BMJ. 1998;316(7131):589-92.

Jick SS, Jick H. Cerebral venous sinus thrombosis in users of four hormonal contraceptives: levonorgestrel-containing oral contraceptives, norgestimate-containing oral contraceptives, desogestrel-containing oral contraceptives and the contraceptive patch. Contraception. 2006;74(4):290-2. http://dx.doi.org/10.1016/j.contraception.2006.05.071

Linn J, Pfefferkorn T, Ivanicova K, Müller-Schunk S, Hartz S, Wiesmann M, et al. Non contrast ct in deep cerebral venous thrombosis and sinus thrombosis: comparison of its diagnostic value for both entities. AJNR Am J Neuroradiol. 30(4):728-35. http://dx.doi.org/10.3174/ajnr.A1451

Smith AB, Smirniotopoulos JG, Rushing EJ, Goldstein SJ. Bilateral thalamic lesions. AJR Am J Roentgenol. 2009;192(2): W53-W62. http://dx.doi.org/10.2214/AJR.08.1585

Gossner J1, Larsen J, Knauth M. Bilateral thalamic infarction- a rare manifestation of dural venous sinus thrombosis. Clin Imaging. 2010;34(2):134-37. http://dx.doi.org/10.1016/j.clinimag.2009.05.008

Lõvblad KO, Bassetti C, Schneider J, Ozdoba C, Remonda L, Schroth G. Diffusion-weighted mri suggest the coexistance of cytotoxic and vasogenic edema in a case of deep cerebral venous thrombosis. Neuroradiology.2000;42(10):728-31.

Ducreux D, Oppenheim C. Diffusion-weighted imaging patterns of brain damage associated with cerebral venous thrombosis. AJNR Am J Neuroradiol. 2001;22(2):261-68.

Countinho JM. Cerebral venous thrombosis. J Thromb Haemost. 2015;13(Suppl. 1): S238-S244. http://dx.doi.org/10.1111/jth.12945

Martinelli I, Passamonti SM, Rossi E, De Stefano V. Cerebral sinus-venous thrombosis. Intern Emerg Med. 2012;7(Suppl 3):S221-S225. http://dx.doi.org/10.1007/s11739-012-0806-9

Siddiqui FM, Dandapat S, Banerjee C, Zuurbier SM, Johnson M, Stam J, Coutinho JM. Mechanical Thrombectomy in Cerebral Venous Thrombosis Systematic Review of 185 Cases. Stroke. 2015;46(5):1263-68. http://dx.doi.org/10.1161/STROKEAHA.114.007465

Ilyas A, Chen CJ, Raper DM, Ding D, Buell T, Mastorakos P, et al. Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: a systematic review. J NeuroInter-vent Surg. 2017;9(11):1086-1092. http://dx.doi.org/10.1136/neurintsurg-2016-012938

Shui SF, Li TF, Han XW, Ma J, Guo D. Balloon dilatation and thrombus extraction for the treatment of cerebral venous sinus thrombosis. Neurol India. 2014;62(4):371-75. http://dx.doi.org/10.4103/0028-3886.141241

Ma J, Shui S, Han X, Guo D, Li TF, Yan L. Mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis. Acta Radiol. 2016;57(2): 1524-30. http://dx.doi.org/10.1177/0284185116633912

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Downloads

Download data is not yet available.