Please wait a minute...
Reviews in Cardiovascular Medicine  2018, Vol. 19 Issue (4): 129-133     DOI: 10.31083/j.rcm.2018.04.4081
Case Review Previous articles | Next articles
Pitfalls in the diagnosis and initial management of acute cerebral venous thrombosis
Huaying Cai1, Xiaobin Ye1, 2, Weiliang Zheng3, Li Ma4, Xingyue Hu1, *(), Xing Jin1, *()
1 Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University. No.3 East Qingchun Rd., Hangzhou, Zhejiang, China, 310020
2 Department of Neurology, Wen Ling Hospital of Traditional Chinese Medicine. No.21 North Mingyuan Rd. Taizhou, Zhejiang, China, 317500
3 Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University. No.3 East Qingchun Rd., Hangzhou, China, 310020
4 Department of Neurology, Shao Xing No. 2 People’s Hospital. No.147 Yanan Rd. Shaoxing, Zhejiang, China, 312000
Download:  PDF(1797KB)  ( 1614 )
Export:  BibTeX | EndNote (RIS)      
Abstract:
Cerebral venous thrombosis is an important etiology of stroke in young patients. Its clinical manifestations are variable and based on different involved venous or sinus processes. Cerebral venous thrombosis could mimic ischemic infarction and is easy to misdiagnose. Although many patients have favorable outcomes, delayed or incorrect diagnosis due to atypical symptoms may lead to a poor prognosis. Here we present a case of a 33-year-old woman with transient headache and recurrent right extremity weakness whose symptoms progressed and were sustained in the hospital. She was diagnosed with ischemic infarction and recombinant tissue plasminogen activator (rtPA) thrombolysis was performed. However, her symptoms progressed, and intracranial hematoma was found on a computed tomography scan. Ruling out other hemorrhage etiology, we confirmed the presence of cerebral venous thrombosis using magnetic resonance venography. She underwent mechanical thrombectomy and her condition improved thereafter. This case raises the awareness that in young woman patients on oral contraceptives with neurological deficits and headache, cerebral venous thrombosis is a considerable diagnosis. A contrast CT or MRI scan should be ordered in the early course of evaluation, which can help the physician to make the right clinical decision.
Key words:  Cerebral venous thrombosis      recombinant tissue plasminogen activator      catheter-based local thrombolysis      thrombectomy     
Published:  30 December 2018     
Fund: 81400926/The Natural Science Foundation of China
2018RC045/Health General Research Project of Zhejiang Province, China
LY19H090027/The Natural Science Foundation of Zhejiang Province of China
*Corresponding Author(s):  Xing Jin, E-mail: jxmartin@zju.edu.cn; Xingyue Hu, E-mail: huxingyue2003@zju.edu.cn   

Cite this article: 

Huaying Cai, Xiaobin Ye, Weiliang Zheng, Li Ma, Xingyue Hu, Xing Jin. Pitfalls in the diagnosis and initial management of acute cerebral venous thrombosis. Reviews in Cardiovascular Medicine, 2018, 19(4): 129-133.

URL: 

https://rcm.imrpress.com/EN/10.31083/j.rcm.2018.04.4081     OR     https://rcm.imrpress.com/EN/Y2018/V19/I4/129

[1] Alshurafa S, Alfilfil W, Alshurafa A, et al. Cerebral venous sinus thrombosis in a young female misdiagnosed as migraine ending in a permanent vegetative state: A case report and review of the literature. Journal of Medical Case Reports. 2018;12:323.
[2] Canhão P, Falcão F, Ferro JM. Thrombolytics for cerebral sinus thrombosis: A systematic review. Cerebrovascular Diseases. 2003;15:159-166.
[3] Canhao P, Ferro JM, Lindgren AG, et al. Causes and predictors of death in cerebral venous thrombosis. Stroke. 2005;36:1720-1725.
[4] Coutinho JM, Zuurbie SM, Aramideh M, et al. The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke: a Journal of Cerebral Circulation. 2012;43:3375-3377.
[5] Dentali F, Squizzato A, Gianni M, et al. Safety of thrombolysis in cerebral venous thrombosis. A systematic review of the literature. Thrombosis and Haemostasis. 2010;104:1055-1062.
[6] Ferro JM. Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke. 2004;35:664-670.
[7] Ferro JM, Bousser MG, Canhão P, et al. European stroke organization guideline for the diagnosis and treatment of cerebral venous thrombosis-endorsed by the European Academy of Neurology. European Journal of Neurology. 2017;24:1203-1213.
[8] Guo X, Guan S, Fan Y, et al. Local thrombolysis for severe cerebral venous sinus thrombosis. American Journal of Neuroradiology. 2012;33:1187-1190.
[9] Gupta RK, Jamjoom AAB, Devkota UP. Superior sagittal sinus thrombosis presenting as a continuous headache: A case report and review of the literature. Cases Journal. 2009;21:1-4.
[10] Iqbal N, Sharma A. Cerebral venous thrombosis: a mimic of brain metastases in colorectal cancer associated with a better prognosis. Case Reports in Oncological Medicine. 2013;2013:1-3.
[11] Li G, Zeng X, Hussain M, et al. Safety and validity of mechanical thrombectomy and thrombolysis on severe cerebral venous dinus thrombosis. Neurosurgery. 2013:72:730-738.
[12] Pai N, Ghosh K, Shetty S. Hereditary thrombophilia in cerebral venous thrombosis. Blood Coagulation & Fibrinolysis. 2013;24:540-543.
[13] Saadatnia M , Tajmirriahi M. Hormonal contraceptives as a risk factor for cerebral venous and sinus thrombosis. Acta Neurologica Scandinavica. 2007;115:295-300.
[14] Saposnik G, Barinagarrementeria F, Brown RD, et al. Diagnosis and management of cerebral venous thrombosis: A statement for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2011;42:1158-1192.
[15] Siddiqui FM, Dandapat S, Banerjee C, et al. Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke. 2015;46:1263-1268.
[16] Stam J, de Bruijn S, DeVeber G. Anticoagulation for Cerebral Sinus Thrombosis. Stroke. 2003;34:1054-1055.
[17] Taniguchi D, Nakajima S, Hayashida A, et al. Deep cerebral venous thrombosis mimicking influenza-associated acute necrotizing en-cephalopathy: A case report. Journal of Medical Case Reports. 2017;11:1-6.
[18] Tarani L, Iacobini M, De Stefano V, et al. Recombinant plasminogen activator therapy for cerebral vein thrombosis in a child carrier of prothrombin gene mutation. Journal of Pediatric Hematology/ Oncology. 2002;24:769-771.
[19] Unal AY, Unal A, Goksu E, et al. Cerebral venous thrombosis presenting with headache only and misdiagnosed as subarachnoid hemorrhage. World Journal of Emergency Medicine. 2016;7:234-236.
[20] Viegas LD, Stolz E, Canhão P, et al. Systemic thrombolysis for cerebral venous and dural sinus thrombosis: a systematic review. Cerebrovascular Diseases. 2014;37:43-50.
[21] Wang X, Sun X, Liu H. Clinical analysis and misdiagnosis of cerebral venous thrombosis. Experimental and Therapeutic Medicine. 2012;4:923-927.
[22] Zahrani AMA, Sheikh RA. Cerebral venous sinus thrombosis with an intracranial haemorrhage: a case report. Open Access Macedonian Journal of Medical Sciences. 2019;7:1029-1031.
[1] Ziv J. Haskal. Mechanical Thrombectomy Devices for the Treatment of Peripheral Arterial Occlusions[J]. Reviews in Cardiovascular Medicine, 2002, 3(S2): 45-52.
No Suggested Reading articles found!