Deep Cerebral Venous Thrombosis:a Case Report And Literature Review

[Background and objective]Cerebral venous thrombosis (CVT) is an uncommon type of cerebral vascular diseases, which accounts for0.5%to1.0%. With complicated etiological factors and manifestations, it is hard to be diagnosed early. Deep cerebral venous thrombosis (DCVT) is more rare and dangerous but misdiagnosed frequently. Even given antico-agulants timely, there is still a high rate of deterioration and disabled or death. So far, the researches on DCVT are far from enough. The purpose of this paper is to report a rather rare but severe case of DCVT, who was treated with a new anticoagulation therapy, and provide a review of the literature about the clinical features of DCVT to promote the early diagnosis and management.[Methods](1) In this article, we reported a severe case of DCVT retrospectively treated by the department of Neurology, Qilu Hospital of Shandong University, and recorded the etiological factors, clinical manifestation, laboratory and image findings, the new an-ticoagulation therapy and changes allowing the follow-up.(2) Relevant literature recorded by CNKI and Wanfang Database, was retrospec-tively reviewed with an emphasis on the clinical features of DCVT to provide rec- ommendations for clinic.[Results](1) Case report:A49-year-old woman farmer was sent to our department of neu-rology, complaining headache, nausea and vomiting for2days, and1-day history of somnolence. Diagnosed with DCVT but refractory to single anticoagulant, low mo-lecular weight heparin, she was given both rivaroxaban and low molecular weight heparin simultaneously, which eased the symptoms visibly, and was changed to riva-roxaban alone8weeks later. She was seen in outpatient4months after onset and the rechecked brain MRV showed complete recanalization of the cerebral venous system. Follow-up brain MRI and MRV scans revealed the process of improving and the re-canalization of the thrombotic veins and sinuses. No recurrent CVT or other throm-botic events were observed.(2) Literature review:There were121cases recorded, with43(35.5%) males and78(64.5%) females. The mean age was33.2years old. Among85cases, puerperium, infection, oral contraceptives, pregnancy and dehydration were the etiological factors of24(28.2%),14(16.5),7(8.2%),5(5.9%) and5(5.9%) patients respectively, while the causes of17(20.0%) patients were unclear. The most common clinical manifestation was increased intracranial pressure (73.1%), followed by unconsciousness (46.3%), symptoms of pyramidal system (40.7%), seizure (25.9%). Brain edema was found in all subjects with CT or MRI. Venous infarctions were found in25(20.7%) cases, of which21were hemorrhagic. Only deep venous system was involved for20.5%pa-tients, while50.9%had thrombosis of sinuses except for deep veins.[Conclusions](1) The combination therapy of rivaroxaban and low molecular weight heparin appears to be clinically safe and effective in this patient with severe deep cerebral ve-nous thrombosis. This is the first report of this new combination anticoagulation ther-apy for CVT. However, further studies are needed to evaluate the safety and efficacy.(2) DCVT could occur in any ages, and is common in young especially for women. The etiological factors are similar to other intracranial venous thrombosis, but straight and (or) transverse sinus are often involved with more hemorrhagic infarc- tions. Attention should be put on the publication bias, and more clinical researches are needed to evaluate.