Deep cerebral veins thrombosis and thalamic venous infarction

Case contributed by Dr Ahmed Samir Mehany

Presentation

Repeated attacks of vomiting and a decreased conscious level.

Patient Data

Age: 40 years
Gender: Male

Bilateral thalamic hypodensity more at the right side with increased caliber and attenuation of deep cerebral veins and vein of Galen.

No intracranial hemorrhage.

CT venography shows lack of post-contrast opacification of the deep cerebral veins, vein of Galen, straight, right transverse and sigmoid sinuses suggestive of venous thrombosis.

Normal post contrast opacification of the superior sagittal, left transverse and sigmoid sinuses as well as internal jugular veins bilaterally.

Markedly increased hypodensity of brain white matter and basal ganglia associated with effacement of cortical sulci and relative sulcal hyperdensities (pseudosubarachnoid hemorrhage sign), findings represent advanced cerebral edema.

Case Discussion

The patient presented with repeated vomiting and decreased conscious level, CT brain was asked to exclude central cause and CT venography was arranged immediately to confirm the diagnosis and determine the extent of the disease.

There was progressive deterioration of the conscious level, follow-up CT after about 24 hours revealed a progression of findings. The patient died 2 days later.

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Case information

rID: 68484
Published: 5th Jun 2019
Last edited: 5th Jun 2019
Inclusion in quiz mode: Included

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