Resolution of Bilateral Thalamic Lesions Due to Deep Cerebral Venous Thrombosis

Abstract

T W O P R E V I O U S L Y healthy female patients (aged 18 and 49 years) were admitted because of a headache of rapid onset along with vomiting followed by an apathetic state. Neurological status revealed abulia and massive frontal release signs. Acute magnetic resonance imaging showed bilateral thalamic hyperintensities on T2-weighted images (Figure 1) and deep cerebral venous thrombosis was confirmed by venous magnetic resonance angiography. Both patients were treated with intravenous heparin followed by oral anticoagulation. The first patient showed complete clinical, cognitive, and radiological recovery within 3 months (Figure 2A). The second patient had very mild persistent memory deficits at 6 months, but she was still able to return to work as a teacher. Her 6-month follow-up T2-weighted magnetic resonance imaging scan revealed only discrete bilateral thalamocapsular hyperintensities (Figure 2B). The involvement of the deep system in intracranial venous thrombosis has already been associated with a worse prognosis. However, the best treatment for this situation remains controversial. While some propose the use of thrombolytics, their indication and safety need further investigation. Anticoagulation alone seems to be efficient and our 2 cases illustrate that it may be sufficient.