Deep cerebral venous thrombosis (DCVT) remains a very rare entity among the spectrum of cerebral venous thrombosis (CVT). Due to the bilateral draining territories, DCVT nearly invariably causes bilateral infarction with predictably dismal prognosis. However, rare instances of DCVT with unilateral infarction having favorable prognosis have been described, but pose a wide range of differentials to the clinician and require careful interpretation of clinical and radiological features for accurate diagnosis. Here, we report two unusual cases of DCVT with unilateral thalamic infarction with excellent outcome. We also report a rare case of CVT, with simultaneous deep and cortical vein thrombosis. Through a relevant review of the literature, we also examine the clinical presentations of unilateral infarction due to DCVT and their outcomes.

Unilateral Thalamic Infarct: A Rare Presentation of Deep Cerebral Venous Thrombosis

Cortical venous thrombosis (CVT) is a common and frequently unrecognized type of stroke that affects approximately five people per million annually and accounts for 0.5-1% of all strokes. Exact incidence in India is yet to be documented. Puerperal CVT may account for the majority of CVT cases in India. Cerebral venous sinus thrombosis (CVST) usually affects young to middle aged groups. Outcome of CVST patients may vary from complete recovery to permanent neurological deficits, with varying presentation of the natural course of the disease. Factors related to poor outcome were papilledema, altered consciousness, coma, age older than 33 years, diagnostic delay >10 days, intracerebral hemorrhage, and involvement of the straight sinus. This case report is of thrombosis in the deep venous system of brain causing venous infarction of unilateral thalamus. There are very few cases reported all over the world with unilateral thalamic venous infarct. Prognosis of unilateral deep cerebral vein thrombosis is said to be better than that of bilateral thrombosis, if detected early and timely treated. Patient with a unilateral thrombosis may show complete recovery from his neurologic symptoms. Reports of reversible edema of the thalamus are well documented. In this case, patient is overall well preserved except that he continues to have recent memory impairment even after 4 weeks of discharge from hospital.

A case of unilateral thalamic venous hemorrhagic infarct in deep venous system thrombosis

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A case of unilateral thalamic venous hemorrhagic infarct in deep venous system thrombosis