Document Detail

Cerebral vein thrombosis associated with aneurysmal subarachnoid bleeding: implications for treatment.
MedLine Citation:
PMID:  14706394     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cerebral vein thrombosis associated with aneurysmal subarachnoid bleeding is an uncommon event rarely described in the literature. We report here a case and summarize the problems in the management of this patient. CASE DESCRIPTION: A 48-year-old female suffered from two episodes of severe headache and vomiting 7 days before and on the day of admission. She was deeply somnolent with mild paresis of her right leg. Computed tomography (CT) scans revealed diffuse basal subarachnoid bleeding and a left parietal subcortical hemorrhagic area. A cerebral angiogram demonstrated an anterior communicating artery aneurysm. The angiographic late venous phase showed nonopacification of the cortical veins on the hemorrhagic area compatible with cerebral vein thrombosis. She underwent successful aneurysm clipping combined with moderate systemic anticoagulation. After 7 days of gradual clinical improvement she presented acute bilateral cerebral herniation signs and died 48 hours later. CT scan showed a generalized brain swelling. Postmortem examination confirmed the correct occlusion of the ruptured aneurysm sac and the presence of a postthrombotic subcortical left parietal hemorrhage as well as a complete obstruction of the superior sagittal sinus extended into both transverse sinus. CONCLUSIONS: The fatal outcome with the documented extended thrombosis, despite careful anticoagulation therapy, indicates the necessity of closely meshed follow-up studies examining the sinus patency in such complicated cases with associated pathology.
Mario Carvi y Nievas; Eberhard Haas; Hans-Georg Höllerhage; Thomas Lorey; Peter-Josef Klein
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Surgical neurology     Volume:  61     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-01-06     Completed Date:  2004-02-18     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  95-8; discussion 98     Citation Subset:  IM    
Neurosurgical Clinic and Pathological Institute, Akademisches Lehrkrankenhaus der, Johann-Wolfgang-Goethe-Universität Frankfurt A.M. Main, FFM- Höchst, Germany.
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MeSH Terms
Brain / blood supply
Cerebral Angiography
Cerebral Veins / radiography*,  surgery
Diagnosis, Differential
Fatal Outcome
Headache / diagnosis
Intracranial Aneurysm / complications,  diagnosis,  surgery
Middle Aged
Neurosurgical Procedures / methods
Postoperative Complications
Subarachnoid Hemorrhage / complications*,  diagnosis,  surgery
Tomography, X-Ray Computed
Venous Thrombosis / diagnosis*,  etiology*,  surgery
Vomiting / etiology

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