Cerebral Venous Sinus Thrombosis Associated with Systemic Multiple Hemangiomas Manifesting as Chronic Subdural Hematoma —Case Report—

Abstract

A 35-year-old male was admitted with headache, nausea, and vomiting persisting for 2 days. Computed tomography (CT) revealed a left chronic subdural hematoma. Cerebral angiography demonstrated cerebral venous sinus thrombosis (CVST). He had presented with a subcutaneous mass involving the neck at age 2 years, which was shown to be a cavernous angioma, and thereafter shown signs of consumptive coagulopathy with systemic multiple hemangiomas. Burr hole aspiration of the hematoma was performed. Seventy-two-hours later, he developed clouding of consciousness and right hemiparesis. CT revealed a fresh hematoma in the operated subdural cavity and hemorrhagic diathesis manifested. A frontotemporoparietal large craniotomy was performed to remove the hematoma. Extensive electrocauterization was required. He had a satisfactory postoperative course. Collateral venous pathways, resulting from the CVST due to systemic multiple hemangiomas, may have caused hemodynamic stress in the bridging veins which subsequently induced chronic subdural hematoma.

Does Intracranial Venous Thrombosis Cause Subdural Hemorrhage in the Pediatric Population?

“…12,13 The theory that dural venous sinus thrombosis leads to increased pressure or tension in cortical veins and thus results in subdural bleeding was not observed in any patient in this retrospective study. [4][5][6][7]14 Our careful review of case reports that suggest IVT as an initiating event leading to SDH reveals that they barely satisfy the criteria for level III quality data, as established by the US Preventive Services Task Force. In fact, even in 1937, Bailey and Hass elegantly described 3 pediatric patients with IVT, 2 of whom had SDH at autopsy.…”

“…Takamura et al reported on a 35-year-old man with multiple systemic hemangiomas, cerebral venous thrombosis, consumptive coagulopathy, and chronic left SDH. 14 The authors postulated that collateral venous pathways caused hemodynamic stress and rupture of bridging veins, leading to SDH. In addition, the authors reported multiple areas of dural-based enhancement on MR imaging, leading to speculation that if the dura were involved with cavernous hemangiomata, the patient would reasonably be predisposed to develop SDH.…”

“…15 Neither the previous mentioned case reports nor the autopsy series of Bailey and Hass described findings to support pre-existing elevated intracranial pressure. [4][5][6][7]14 Other clinical and imaging observations observed in conjunction with IVT include brain herniation syndromes, cerebral ischemia, or strokes that one might observe with acute states of intracranial hypertension, secondary to acute IVT, were also not described. [4][5][6][7]14,15 Therefore, in concordance with the literature, our study also does not support the correlation of IVT with SDH.…”

Cerebral Venous Sinus Thrombosis in an Adult Patient Presenting as Headache and Acute Subdural Hematoma

“…Adult CVSTs presented as chronic subdural hematomas have also reported previously. 6,7 In those cases, the etiology was presumed to be the collapse of bridging collaterals by hemodynamic stress caused by CVST. 7 On the other hand, there are 2 previous case reports on patients with acute subdural hematoma in association with ASDH.…”

Angioma venoso asociado a hemorragia cerebelosa. Presentación de un caso

“…La ataxia y las alteraciones en la marcha pueden observarse en aquellos pacientes con lesiones infratentoriales. La trombosis de la vena de drenaje es una complicación poco habitual que puede ocasionar infarto venoso no hemorrágico, aunque la rotura de una malformación venosa tras la trombosis aguda de su vena de drenaje puede dar lugar a hemorragia [11][12][13][14][15] . En estos casos, los estudios de imagen demuestran que existe una progresiva recanalización de la malformación pudiendo estas sangrar espontáneamente, explicándose como causas del sangrado un aumento de presión intralesional por la trombosis de la vena de drenaje 3 .…”