Bilateral thalamic infarcts due to deep cerebral venous thrombosis: clinical and radiological findings

Infarto bitalámico por trombosis venosa cerebral profunda hallazgos clínicos y radiológicos

Cerebrovascular disease is a global public health problem and is a major cause of mortality. Cerebral venous thrombosis (CVT) is an uncommon but serious type of cerebrovascular disease. Thus, we report two cases of bilateral thalamic infarcts secondary to deep cerebral venous thrombosis presenting with unusual clinical and radiological features which made diagnosis more difficult. The functional complexity of the thalamus and the uncommon presentation of deep cerebral venous thrombosis lead to atypical clinical manifestations hence various conditions are considered in the differential diagnosis at onset of the event. Therefore, we emphasize the importance of conducting future studies with a larger sample size in order to further elucidate the clinical and radiological characteristics of this condition.

1. Traylor M, Farrall M, Holliday EG, Sudlow C, Hopewell JC, Cheng YC, et al. Genetic risk factors for ischaemic stroke and its subtypes (the METASTROKE collaboration): a meta-analysis of genome-wide association studies. Lancet Neurol. 2012;11(11):951-62. doi: 10.1016/S1474-4422(12)70234-X.
2. Lavados PM, Hennis AJ, Fernandes JG, Medina MT, Legetic B, Hoppe A, et al. Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean. Lancet Neurol. 2007;6(4):362-72. doi: 10.1016/S1474-4422(07)70003-0
3. Ribes F. Exposé succinct des recherches faites sur la phlébite: Gueffier; 1825.
4. Ferro JM, Correia M, Pontes C, et al. Cerebral vein and dural sinus thrombosis in Portugal: 1980-1998. Cerebrovasc Dis 2001; doi: 11:177. 10.1159/000047635
5. Devasagayam S, Wyatt B, Leyden J, Kleinig T. Cerebral Venous Sinus Thrombosis Incidence Is Higher Than Previously Thought: A Retrospective Population-Based Study. Stroke 2016; 47:2180. doi: 10.1161/STROKEAHA.116.013617.
6. deVeber G, Andrew M, Adams C, et al. Cerebral sinovenous thrombosis in children. N Engl J Med 2001; 345:417. doi: 10.1056/NEJM200108093450604
7. Lanska DJ, Kryscio RJ. Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis. Stroke 2000; 31:1274.
8. Guenther G, Arauz A. Cerebral venous thrombosis: a diagnostic and treatment update. Neurologia. octubre de 2011;26(8):488-98. doi: 10.1016/j.nrl.2010.09.013.
9. Bushnell C, Saposnik G. Evaluation and management of cerebral venous thrombosis. Continuum (Minneap Minn). abril de 2014;20(2 Cerebrovascular Disease):335-51. doi: 10.1212/01.CON.0000446105.67173.a8.
10. Narra R, Kamaraju SK, Pasupaleti B, Juluri N. Case of cerebral venous thrombosis with unusual venous infarcts. J Clin Diagn Res. abril de 2015;9(4):TD08 doi: 10.7860/JCDR/2015/12264.5848.
11. Meder JF, Chiras J, Roland J, Guinet P, Bracard S, Bargy F. Venous territories of the brain. J Neuroradiol. 1994;21(2):118-33.
12. Wang X, Sun X, Liu H. Clinical analysis and misdiagnosis of cerebral venous thrombosis. Exp Ther Med. 2012;4(5):923-7. doi: 10.3892/etm.2012.697
13. Hegde AN, Mohan S, Lath N, Lim CCT. Differential diagnosis for bilateral abnormalities of the basal ganglia and thalamus. Radiographics. febrero de 2011;31(1):5-30. doi: 10.1148/rg.311105041.
14. Sandra Monroy Rojas, Luis Jiménez Orozco, Nohemí Meza Cely, Juan Salcedo. Infarto talámico bilateral por obstrucción de la arteria de Percherón: reporte de caso. Acta Neurol Colomb. 2017; 33(2): 104-114.
15. Olesen J, Bes A. III Edición de la clasificación internacional de las cefaleas. 3 ed. :International headache society; 2013
16. Silvis SM, De Sousa DA et al. Cerebral venous thrombosis. Nat Rev Neurol. 2017 Sep;13(9):555-565
17. 16. Bousser MG et al. Cerebral venous thrombosis: an update. Lancet Neurol 2007; 6: 162–70
18. Saposnik G, Barinagarrementeria F, Brown RDJ, Bushnell CD, Cucchiara B, Cushman M, 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(4):1158-92.
19. Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics. octubre de 2006;26 Suppl 1:S19-41; discussion S42-43.
20. Ferro JM, Bousser M-G, Canhao P, Coutinho JM, Crassard I, Dentali F, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol. 2017;24(10):1203-13.
21. Adrián Zamora (1), Victor Hugo Bastos (2), Juan Camilo Márquez (3), Jessica Zuleta (4). Isquemia talámica bilateral secundaria a trombosis venosa cerebral: tratamiento endovascular, presentación de un caso. Acta Neurol Colomb. 2017; 33(4): 279-285.
22. Crawford SC, Digre KB, Palmer CA, Bell DA, Osborn AG. Thrombosis of the deep venous drainage of the brain in adults. Analysis of seven cases with review of the literature. Arch Neurol. 1995;52(11):1101-8.
23. 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(3):233-6.