Thrombosis of the Superior Petrosal Vein Mimicking Brain Tumor -Case Report-

Abstract

A 77-year-old woman was admitted to a local hospital with a 7-day history of vertigo and nausea, followed by gait disturbance. Magnetic resonance imaging showed extensive brain edema with a hemorrhagic component in the right cerebellum. The lesion was heterogeneously enhanced after administration of contrast medium. The presumptive diagnosis was malignant glioma based on these findings, as well as the presence of mass effect and abnormal enhancement. She was referred to our hospital. However, cerebral angiography did not reveal tumor stain or arterial occlusion, but confirmed corkscrew-like venous collaterals and absence of opacification of the superior petrosal vein (SPV) and superior petrosal sinus. Topography of the brain edema was consistent with the drainage territory of the SPV. These findings suggested that the lesion was vasogenic edema caused by thrombosis of the SPV. The patient was conservatively treated without anticoagulation therapy, and the neurological and imaging abnormalities resolved spontaneously. To avoid unnecessary biopsy, thrombosis of the SPV should be considered in the differential diagnosis of infratentorial lesion mimicking brain tumors. Knowledge of the posterior fossa venous anatomy is essential to achieve the correct diagnosis.

Isolated Vein Thrombosis of the Posterior Fossa Presenting as Localized Cerebellar Venous Infarctions or Hemorrhages

“…Venous infarctions in the posterior fossa result from thrombosis of the lateral and straight sinuses as well as the superior petrosal vein. [2][3][4][5][6][7][8] In our present report, the most frequent sinuses affected were the straight and lateral followed by the petrosal vein. The reason for the rarity of isolated venous thrombosis of the posterior fossa could be the abundant collateral venous drainage of the posterior structures, which prevents blood flow stasis in this area.…”

“…Furthermore, it has been reported that a venous infarction due to isolated venous thrombosis of the posterior fossa can also present gadolinium enhancement, making the diagnostic analysis even more confusing. 8 Indeed, our study has several limitations that should be addressed. This is a retrospective analysis of patients prospectively included in a research database designed to address different objectives.…”

“…As shown by the medical literature, this is a rare form of IVT, and therefore, it is often unsuspected in clinical practice. [2][3][4][5][6][7][8] As a consequence, scientific reports are scarce, mostly associating this condition with chronic suppurative processes or with surgical intervention of the posterior fossa. The parenchymal finding most frequently reported in isolated vein thrombosis of the posterior fossa is cerebellar venous infarction with or without a hemorrhagic component, but it can also present as a pure intracerebellar hemorrhage ( Figure).…”

“…The parenchymal finding most frequently reported in isolated vein thrombosis of the posterior fossa is cerebellar venous infarction with or without a hemorrhagic component, but it can also present as a pure intracerebellar hemorrhage ( Figure). [2][3][4][5][6][7][8] We report on cases with isolated venous thrombosis of the posterior fossa selected from a large case series of Mexican patients with IVT. Our aim was to provide further knowledge on the clinical presentation, radiological features, and outcome at discharge of this rare form of venous thrombosis.…”

Cerebral Venous Thrombosis Causing Posterior Fossa Lesions: Description of a Case Series and Assessment of Safety of Anticoagulation

“…The clinical features and outcome of patients with CVT and posterior fossa lesions have been addressed only in two previous small series, with nine and six patients, respectively [3,4] and case reports [5,6,7,8,9,10,11,12,13,14,15,16,17], which all together account for less than 30 patients.…”