Cerebral venous thrombosis in a gentleman presenting with fever, convulsion and frontotemporal haemorrhages.
Cerebral venous thrombosis (CVT) is an uncommon but serious type of stroke. Thrombosis may involve the cortical or deep veins or the venous sinuses. The presenting clinical features are non-specific. We report a 48-year-old man with CVT who presented with fever, bitemporal throbbing headache, and generalised convulsion. Computed tomography (CT) of the brain revealed acute haemorrhages over right anterior frontal and posterior temporal regions with surrounding oedema and right anterior temporal subcortical oedema. The initial diagnosis was herpes simplex encephalitis. Absence of venous flow over the right transverse and sigmoid sinuses during the venous phase of digital subtraction angiography (DSA) revealed CVT. He was anti-coagulated for 6 months. An underlying cause of CVT was not detected. A high index of suspicion is required when risk factors of CVT are present. CT brain may be normal or showing non-specific findings. Magnetic resonance imaging plus venography, CT venography, or DSA is diagnostic.
Chan
K H
KH
Division of Neurology, University Department of Medicine, Queen Mary Hospital, Pokfulam, Hong Kong.
Cheung
R T F
RT
Liu
W M
WM
Mak
W
W
Ho
S L
SL
D015901:Angiography, Digital Subtraction; D000925:Anticoagulants / Q000627:therapeutic use; D001921:Brain / Q000098:blood supply*; D003937:Diagnosis, Differential; D020803:Encephalitis, Herpes Simplex / Q000473:pathology; D005334:Fever / Q000209:etiology*; D005625:Frontal Lobe / Q000473:pathology; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D020767:Intracranial Thrombosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology*; D013702:Temporal Lobe / Q000473:pathology; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin