• Users Online: 488
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 24  |  Issue : 3  |  Page : 146-147

A rare case of right-sided unilateral thalamic edema due to internal cerebral vein thrombosis


1 Department of Medicine, MH Amabala, Amabala, Haryana, India
2 Department of Radiodiagnosis, CH (EC) Kolkata, Kolkata, West Bengal, India

Date of Submission05-Dec-2021
Date of Decision20-Dec-2021
Date of Acceptance25-Dec-2021
Date of Web Publication01-Jul-2022

Correspondence Address:
Dr. Nagesh Venkata Ivaturi
Department of Medicine, MH Amabala, Haryana
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_152_21

Rights and Permissions
  Abstract 


32 yr old individual presented with headaches and detected to have cerebral venomous thrombosis. MRI revealed internal cerebral vein thrombosis with unilateral that edema. He was managed conservatively.

Keywords: Cerebral vein thrombosis, internal cerebral vein, unilateralthalamic edema


How to cite this article:
Ivaturi NV, Gopinath M. A rare case of right-sided unilateral thalamic edema due to internal cerebral vein thrombosis. J Mar Med Soc 2022;24, Suppl S1:146-7

How to cite this URL:
Ivaturi NV, Gopinath M. A rare case of right-sided unilateral thalamic edema due to internal cerebral vein thrombosis. J Mar Med Soc [serial online] 2022 [cited 2022 Aug 18];24, Suppl S1:146-7. Available from: https://www.marinemedicalsociety.in/text.asp?2022/24/3/146/347867




  Introduction Top


Acute cerebral deep venous thrombosis of internal cerebral veins, vein of Galen, and straight sinus without the involvement of sagittal sinus is very rare.[1] Bilateral thalamic edema associated with venous thrombosis of internal cerebral veins is commonly described in the literature. However unilateral thalamic edema is very rare. We report a case of reversible unilateral thalamic edema with internal cerebral vein thrombosis.


  Case Report Top


A 32-year-old male, staying at a high altitude area (12,000ft) for more than 6 months presented with complaints of the headache of 6 weeks duration. There was no history of vomiting, loss of consciousness, convulsions, fever, weakness of limbs, or sensory symptoms. The headache was continuous and persisting for most of the day and increased intensity while waking up from bed. Clinical examination revealed a heart rate of 86/min, blood pressure 136/86 mm of Hg, respiratory rate of 20/min. Systemic examination was normal. Visual acuity and fundoscopic examination were normal. Investigations revealed normal hematological and coagulation parameters. Electrocardiogram, chest radiograph, and 2D echocardiography, were normal. The findings of computerized tomographic and magnetic resonance imaging of the brain revealed unilateral thalamic edema (Rt) with Internal cerebral vein thrombosis as depicted in [Figure 1].
Figure 1: (a) NCCT Axial, (b) T1 SPGR Axial, (c) T2 Axial, (d) FLAIR (Fluid Attenuated Inversion Recovery) Axial, (e) MIP (Maximum Intensity Projection) of 2D Time of Flight MR Venography

Click here to view


He was managed injection low-molecular-weight heparin enoxaparin 60 mg S/C bd. The headache was subsided after 7 days.


  Discussion Top


Thrombosis of dural sinuses and/or cerebral veins is an uncommon form of stroke, constituting 0.5%–1% of all strokes.[1] Deep cerebral vein thrombosis that affects only single thalamus is a rare entity.[2] The incidence of thrombosis of the deep cerebral system constitutes 11% of all cerebral venous thrombosis.[3] The deep venous system consists only of the internal cerebral veins, the basilar veins (vein of Rosenthal), the vein of Galen, and their tributaries. Both thalami drain into the vein of Galen and straight sinus, hence bilateral thalamic edema is commonly encountered with internal cerebral vein thrombosis. Unilateral thalamic edema may be due to collateral drainage of the thalamus.[3] Thrombosis of the deep venous system, the straight sinus, and its branches causes centrally located often bilateral thalamic lesions but in this case, the lesions are unilateral which is very rare.[4] Most of the reported cases in the literature, the infarction has been on the left side,[5] but in our case, the thalamic edema was on the right side. It may be due to anatomic variant predisposing to the left-sided system, especially the left internal cerebral vein with insufficient collateral venous drainage of the thalamus.

The risk factors for venous thrombosis are linked classically to Virchow's triad of, stasis of blood, changes in the vessel wall and changes in components of blood.

The pathophysiology of symptoms in cerebral venous thrombosis can be explained by two mechanisms. In the case of occlusion of deep cerebral veins as it happened in this case, causes localized edema (either due to cytotoxic or vasogenic), and second is the development of raised intracranial hypertension as a result of occlusion of major sinuses.[4]

Most of the symptoms of internal cerebral vein thrombosis are nonspecific.[3] They can cover a wide range of symptoms from headache, nausea, and vomiting to focal neurologic deficits, hemiparesis, aphasia, seizures, coma, and death.[6] This case concerns a benign form of deep cerebral venous thrombosis with isolated headaches and a normal clinical examination. The mainstay of treatment remains anticoagulation with heparins followed by oral anticoagulation for a minimum of 6 months. The use of these direct intra-sinus thrombolytic techniques and mechanical therapies is controversial and recommended only if clinical deterioration occurs despite the use of anticoagulation, or if the patient develops mass effect from a venous infarction or intracerebral hemorrhage that causes intracranial hypertension resistant to standard therapies.[7]

The outcomes of deep cerebral vein thrombosis vary greatly and from complete recovery to death. Unilateral lesions carry a better prognosis than bilateral lesions.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol 2007;6:162-70.  Back to cited text no. 1
    
2.
Herrmann KA, Sporer B, Yousry TA. Thrombosis of the internal cerebral vein associated with transient unilateral thalamic edema: A case report and review of the literature. AJNR Am J Neuroradiol 2004;25:1351-5.  Back to cited text no. 2
    
3.
Menon D, Sarojam MK, Gopal R. Unilateral thalamic infarct: A rare presentation of deep cerebral venous thrombosis. Ann Indian Acad Neurol 2019;22:221-4.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Chung SW, Hwang SN, Min BK, Kwon JT, Nam TK, Lee BH. Unilateral thrombosis of a deep cerebral vein associated with transient unilateral thalamic edema. J Cerebrovasc Endovasc Neurosurg 2012;14:233-6.  Back to cited text no. 4
    
5.
Küker W, Schmidt F, Friese S, Block F, Weller M. Unilateral thalamic edema in internal cerebral venous thrombosis: Is it mostly left? Cerebrovasc Dis 2001;12:341-5.  Back to cited text no. 5
    
6.
Manolidis S, Kutz JW Jr. Diagnosis and management of lateral sinus thrombosis. Otol Neurotol 2005;26:1045-51.  Back to cited text no. 6
    
7.
Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med 2005;352:1791-8.  Back to cited text no. 7
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed62    
    Printed0    
    Emailed0    
    PDF Downloaded10    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]