Diagnosis and treatment of 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.