Resolution of Bilateral Thalamic Lesions Due to Deep Cerebral Venous Thrombosis

Bezerra, Daniel C.; Michel, Patrik; Maulaz, Alexandre B.; Binaghi, Stefano; Bogousslavsky, Julien

doi:10.1001/archneur.62.10.1638

Cited by 9 publications

(6 citation statements)

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“…DCVT presents with a wide range of symptoms and modes of onset, which can complicate diagnosis of this condition [ 10 ]. The identification of bilateral thalamic lesions by MRI can provide an important clue to diagnosis of DCVT [ 9 , 18 ], but these lesions are also observed in ANE, which is a contributing factor in the misdiagnosis of DCVT [ 3 ]. On clinical examination, it is by no means easy to clearly distinguish ANE from DCVT, particularly if the patient has an influenza infection, because both ANE and DCVT present with nonspecific symptoms such as alteration of consciousness.…”

Section: Discussionmentioning

confidence: 99%

Deep cerebral venous thrombosis mimicking influenza-associated acute necrotizing encephalopathy: a case report

et al. 2017

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BackgroundAcute necrotizing encephalopathy is one of the most devastating neurological complications of influenza virus infection. Acute necrotizing encephalopathy preferentially affects the thalamus bilaterally, as does deep cerebral venous thrombosis, which can lead to misdiagnosis.Case presentationA 52-year-old Japanese woman infected with seasonal influenza B virus presented to the emergency care unit in our hospital with progressive alteration of her level of consciousness. Bilateral thalamic lesions were demonstrated by magnetic resonance imaging, leading to a tentative diagnosis of acute necrotizing encephalopathy. However, she had deep cerebral venous thrombosis, and the presence of diminished signal and enlargement of deep cerebral veins on T2*-weighted imaging contributed to a revised diagnosis of deep cerebral venous thrombosis. Anticoagulant therapy was initiated, leading to her gradual recovery, with recanalization of the deep venous system and straight sinus.ConclusionsTo the best of our knowledge, these results represent the first report of deep cerebral venous thrombosis associated with influenza infection. It is clinically important to recognize that deep cerebral venous thrombosis, although rare, might be one of the neurological complications of influenza infection. In the presence of bilateral thalamic lesions in patients with influenza infection, deep cerebral venous thrombosis should be considered in addition to acute necrotizing encephalopathy. Delays in diagnosis and commencement of anticoagulant therapy can lead to unfavorable outcomes.

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Section: Discussionmentioning

confidence: 99%

Deep cerebral venous thrombosis mimicking influenza-associated acute necrotizing encephalopathy: a case report

et al. 2017

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“…ilateral thalamic edema from venous hypertension may result from deep venous sinus thrombosis or high-flow arteriovenous malformations/fistulae due to arterialized venous outflow (1,4,6,8,12,15). Patients with thalamic dysfunction often present with dementia-like symptoms including cognitive decline, hypersomnolence and abulia (1,4,6,8,12,15).…”

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confidence: 99%

“…Here we present a rare case of thalamic dementia caused by bilateral thalamic venous hypertension secondary to an underlying choroid plexus arteriovenous malformation (AVM) with superimposed straight sinus thrombosis. Choroid plexus AVMs are rare entities and present most frequently with intraventricular hemorrhage due to rupture (1,(3)(4)(5)(6)(7)(8)(9)(11)(12)(13)15,16).…”

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confidence: 99%

Bilateral thalamic edema from coexisting choroid plexus arteriovenous malformation and sinus thrombosis. case report

Kochanski

Johnson²,

Moftakhar³

2016

Turkish Neurosurgery

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Bilateral thalamic dysfunction secondary to venous congestion may result from either venous sinus thrombosis or high flow arteriovenous malformations or a combination of both. We present a case of bilateral thalamic edema resulting from concomitant choroid plexus arteriovenous malformation (AVM) and straight sinus thrombosis and describe our treatment approach. The patient presented with several weeks of progressive confusion and memory deficits. Magnetic resonance imaging and venography (MRI/ MRV) showed bilateral thalamic T2 hyperintensities and straight sinus thrombosis. Subsequent cerebral angiography revealed a choroid plexus AVM within the right lateral ventricle. The patient underwent surgical resection of the AVM resulting in postoperative resolution of bilateral thalamic edema on MRI and improvement of his confusion and memory deficits. This case demonstrates a rare example of reversible bilateral thalamic edema secondary to venous hypertension from both an AVM and sinus occlusion after appropriate treatment of the AVM.

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“…Bilateral thalamic lesions limited to paramedian territories account for about 30% of thalamic strokes (Hermann et al, 2008). Less frequent are the cases consequent to bithalamic infarcts with venous etiology (Bezerra, Michel, Maulaz, Binaghi, & Bogousslavsky, 2005;Gossner, Larsenb, & Knauthc, 2010;Vucic, Lye, & Mackenzie, 2003). Patients with infarction involving these regions typically demonstrate a severe clinical picture, that is usually characterized by the association of vigilance and sleep disorders, vertical gaze palsy, psychic changes, and neuropsychological impairments.…”

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confidence: 99%

Cognitive and behavioral deficits following bilateral thalamic stroke: A longitudinal study

et al. 2013

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We describe behavioral and neuropsychological outcome of a patient (N.S.), who showed a bilateral paramedian thalamic ischemic lesion, with particular reference to the longitudinal evolution of topographical disorientation (TD) and confabulations. We report clinical neuropsychological/behavioral data over a 43-month follow-up. The results show early after the stroke a severe amnesic-confabulatory syndrome with dysexecutive deficits, associated with memory disorders both for visuo-spatial and verbal materials and TD both for known and new places. Behavioral disinhibition and anosognosia for cognitive deficits were also observed. All cognitive impairments have been recovered during the long-term follow-up. Bilateral paramedian thalamic infarcts often lead to severe and long-lasting neurological and cognitive impairments. Only a few cases showed good recovery. Our patient represents an interesting and uncommon case of bilateral paramedian thalamic syndrome with a significant neuropsychological recovery.

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Resolution of Bilateral Thalamic Lesions Due to Deep Cerebral Venous Thrombosis

Cited by 9 publications

References 4 publications

Deep cerebral venous thrombosis mimicking influenza-associated acute necrotizing encephalopathy: a case report

Deep cerebral venous thrombosis mimicking influenza-associated acute necrotizing encephalopathy: a case report

Bilateral thalamic edema from coexisting choroid plexus arteriovenous malformation and sinus thrombosis. case report

Cognitive and behavioral deficits following bilateral thalamic stroke: A longitudinal study

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