[Usefulness of diffusion-weighted magnetic resonance imaging in diagnosis and therapeutic strategy of deep cerebral venous thrombosis: a case report].
We present the usefulness of Diffusion-weighted magnetic resonance images (DWI) in diagnosis and therapeutic strategy of deep cerebral venous thrombosis (VT). We report a 37-year-old man who suffered general convulsion and deep coma. Magnetic resonance imaging (MRI) showed high intensity in the right caudate nuclei and bilateral thalamus on T2-weighted images. DWI showed slightly high intensity in the same area and apparent diffusion coefficient (ADC) is normal or slightly high (0.748-1.100 x 10(-3) mm2/s). Cerebral angiography showed occlusion of straight sinus from basal veins and internal cerebral veins bilaterally. We treated by anticoagulation, ventricle drainage, barubiturate and normothermia therapy with intracranial pressure (ICP) monitoring. We considered endovascular thrombolysis to be dangerous in this case because of hemorrhage and didn't it. ICP was more than 40 mmHg and consciousness was comatose in acute stage, however, ICP gradually got to be normal, consciousness became almost clear and he recovered. Follow-up Cerebral angiography showed recanalization of deep venous thrombosis. Follow-up MRI showed disappearance of high intensity in the right caudate nuclei and bilateral thalamus on T2-weighted images and DWI. In this case, we could predict reversible vasogenic edema by DWI and ADC in VT.
Imada
Yasutaka
Y
Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himehara, Izumo-city, Shimane 693-8555, Japan. yasutaka@spch.izumo.shimane.jp
Ikawa
Fusao
F
Kawamoto
Hitoshi
H
Ohbayashi
Naohiko
N
Matushige
Toshinori
T
Kajihara
Yousuke
Y
Inagawa
Tetuji
T
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001463:Barbiturates / Q000627:therapeutic use; D002550:Cerebral Veins; D004322:Drainage; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007427:Intracranial Pressure; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008991:Monitoring, Physiologic; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*
D000925:Anticoagulants; D001463:Barbiturates; C032232:barbituric acid