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Deep cerebral vein thrombosis

Deep cerebral vein thrombosis is a sub type of cerebral venous thrombosis, and typically involves the internal cerebral veins.

The best diagnostic clue is demonstrating hyperdensity of the veins themselves, often associated with extension of the clot in the vein of Galen and into the straight sinus (see dural venous sinus thrombosis).

Typically the thalami are bilaterally oedematous with potential superimposed venous infarction and haemorrhage, although occasionally the findings will be markedly asymmetric or unilateral  3.  For unknown reasons the right side is more often involved than the left when the involvement is asymmetric or unilateral.

Demographics and clinical presentation

Any age however women on the contraceptive pill are over represented. Presentation is highly variable, but compared to run-of-the-mill dural venous sinus thrombosis is usually shorter and more rapidly progressive to profound deficit 3. Presentation can include:

  • nausea
  • headache
  • focal neurological deficit
  • seizure
  • hemiparesis
  • aphasia
  • coma

Pathology

Predisposing factors
  • oral contraceptive pill (OCP) use
  • prothrombotic conditions
  • adjacent infection / inflammation
  • dehydration

please refer to the generic article for a more complete list : cerebral venous thrombosis

Radiographic features

CT

Non-contrast CT, when not associated with venous haemorrhage or infarction can be a subtle finding, relying on hyperdensity of the ICV being identified.

With contrast administration, especially with a CT venogram, then a filling defect in the veins and sinuses is sought. 

MRI

MRI is able to both visualize the clot as well as the sequelae. 

  • T1 : The acute clot is iso intense becoming hyper intense in the sub acute phase ; see ageing blood on MRI 
  • T2 : acute clot is hypo intense on T2 (this can mimic a flow void)
  • MR venography : will demonstrate lack of flow.

Treatment and prognosis

For general discussion on treatment please refer to the parent article : cerebral venous thrombosis.

Compared to dural venous sinus thrombosis, deep cerebral venous thrombosis, especially when the internal cerebral veins are involved, carries a poorer prognosis 3.

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