Dural sinus thrombosis - A rare manifestation of internal jugular venous occlusion

Abstract

The dural sinus thrombosis is an uncommon complication of a commonly done procedure of central venous catheterisation. We present a case of massive hemorrhagic venous infarct with gross cerebral edema due to dural sinus thrombosis along with right internal jugular vein thrombus. A 21-year-old male patient presented to the emergency department with fever and swelling of the right neck four days following discharge after his prior hospitalization two weeks ago for acute renal failure due to severe gastroenteritis, when he underwent hemodialysis through right internal jugular access. On presentation, he was conscious, with swelling on right side of the neck, which was diagnosed as right internal jugular vein occlusion. However, he rapidly deteriorated and developed signs of raised intracranial pressure despite being on treatment with heparin. He was diagnosed as having massive hemorrhagic cerebral venous infarct with gross cerebral edema complicated with shift of the ventricles to the left due to dural sinus thrombosis. Despite emergency decompressive craniotomy, he succumbed in the next two days due to coning. Asymptomatic catheter-related thrombosis is frequent in the intensive care units, but major complications like retrograde extension into dural sinus causing thrombosis is rare. A high index of suspicion is required to diagnose this major catastrophe for an early and meaningful intervention.

Two cases of aseptic internal jugular vein thrombophlebitis associated with hemodialysis catheter, presenting as sore throat: case report and literature review

“…We searched PubMed using the keywords (internal jugular vein AND catheter AND thrombophlebitis OR thrombosis) and excluded reports with no description of symptoms, treatment, or complications. We retrieved 12 relevant articles (Table 1) [10][11][12][13][14][15][16][17][18][19][20][21]. These articles included 14 patients with catheter-related IJV thrombosis, but only three cases of thrombophlebitis [10,11,13].…”

Nineteen-year-old female with idiopathic thrombosis of the internal jugular vein

“…11 In case of septic emboli, right or left atrial thrombi, pulmonary embolism and dural sinus thrombosis, venous thrombosis may be a fatal condition. 12,13…”

“…11 In case of septic emboli, right or left atrial thrombi, pulmonary embolism and dural sinus thrombosis, venous thrombosis may be a fatal condition. 12,13 Jugular vein thrombosis can be diagnosed by ultrasonography, CT and MRI modalities. However, our patient underwent an MRI in order to exclude any possible bone and soft tissue infectious pathology.…”

Utility of internal jugular vein reconstruction in modified radical neck dissection

“…12 A report of dural sinus thrombosis as a manifestation of IJV occlusion described how gross cerebral edema led to death in that patient. 13 Yu et al 14 reported on the role of cranial venous outflow abnormalities in the development of brain edema after ischemic events which results in further functional compromise. Pseudotumor cerebri following neck dissection has also been documented as a complication caused by venous outflow obstruction in cases where reconstruction of the IJV has not occurred.…”