External Ventricular Drainage in Acute Cerebral Venous Thrombosis with Bilateral Thalamic Infarcts

Abstract

Cerebral venous thrombosis (CVT) is an uncommon type of stroke with a considerable risk of mortality and morbidity (around 15% overall death or dependency rate in recent meta-analysis). We present the case of a 20-month-old girl who presented with an altered level of consciousness and motor impairment. Imaging studies showed deep CVT with bilateral thalamic edema, resulting in obstructive hydrocephalus due to third ventricle compression. An external ventricular drain was placed, along with intracranial pressure (ICP) monitoring. Evolution was favorable with near-complete neurological recovery. Anticoagulation is the mainstay of treatment of CVT. However, there are very few studies addressing shunting procedures in the management of associated intracranial hypertension. We believe that for patients presenting with bilateral thalamic edema and obstructive hydrocephalus, early shunting and ICP monitoring should be considered.