Profile of patients with cerebral venous sinus thrombosis with cerebellar involvement.
BACKGROUND
Cerebral venous thrombosis (CVT) is a rare form stroke with diverse manifestations. There is very little information available regarding profile of patients with cerebellar involvement in CVT. We describe the clinical profile, investigations, and outcome of patients with cerebellar involvement with CVT.


METHODS
We prospectively studied 6 (male:female: 5:1, mean age 29.3 ± 10.3 years) patients of CVT with cerebellar involvement (2 isolated cerebellar and 4 associated deep or supratentorial structures) among 330 CVT patients (1.8%) admitted in our stroke unit during a period of 3 years.


RESULTS
The presenting features (mean duration 7.0 ± 4.7 days) were headache, vomiting, encephalopathy, ataxia, and papilledema. Initial diagnosis considered were neuroinfection in 2 patients, raised intracranial pressure in 2, subarachnoid hemorrhage in 1, and subacute ataxia in 1 patient. Computed tomography (CT) was diagnostic in 3 of 5 patients, whereas magnetic resonance imaging (MRI) and magnetic resonance venography were diagnostic in all; in addition, MRI was superior in detecting new lesions not visualized on CT, in better delineating hemorrhages and in predicting the age of thrombus. Patients were managed medically with anticoagulation, anti-edema, and anti-epileptics and supportive treatment. Two patients underwent posterior fossa decompression. Four patients made complete recovery at the time of discharge and 2 patients died (1 because of brain stem dysfunction and another because of postoperative pneumonia and septicemia).


CONCLUSIONS
Cerebellar involvement in CVT is very rare, and high index of suspicion is required for diagnosis. Imaging with CT and MRI will help in confirming the diagnosis. Conventional anticoagulation is effective in treatment. Mortality was 33%, and there was no disability in survivors.
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. Electronic address: gbk5000@rediffmail.com.
Girish B
GB
Kulkarni
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Veerendrakumar
V
Mustare
Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Mirza M
MM
Abbas
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002526:Cerebellar Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D002531:Cerebellum / Q000098:blood supply*; D002533:Cerebral Angiography; D019299:Decompression, Surgical; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D000925:Anticoagulants
Cerebral venous thrombosis; cerebellar infarction; thrombosis; venous infarction