Cortical vein and transverse sinus thrombosis

Case contributed by Dr Joseph Scheller

Presentation

Several day history of incoordination and altered mental status.

Patient Data

Age: 4 years
Gender: Male

Left transverse sinus thrombosis with left posterior temporal subpial hemorrhage. Right parietal cortical venous thrombosis with right parietal subpial hemorrhage.

Diffusion restriction in the right posterior temporal lobe, right corona radiata and bilateral corpus callosum.

Case Discussion

History: 4-year-old with altered mental status.

Physical exam: Multiple bruises.

Labs: Heterozygous for factor V Leiden mutation.

Imaging: Right cortical vein thrombosis and left transverse sinus thrombosis. Diffusion restriction is much more prominent on the right.

Three lessons to be learned from this case:

  1. Cortical venous thrombosis can have a more dramatic effect on the brain than sinus thrombosis.
  2. When one venous thrombus is found, look for others.
  3. Factor V Leiden puts even a heterozygote at risk.
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Case information

rID: 54946
Case created: 9th Aug 2017
Last edited: 10th Nov 2017
Inclusion in quiz mode: Included

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