Girish B Kulkarni1, Veerendrakumar Mustare2, Mirza M Abbas2. 1. Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. Electronic address: gbk5000@rediffmail.com. 2. Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Abstract
BACKGROUND: Cerebral venous thrombosis (CVT) is a rare form stroke with diverse manifestations. There is very little information available regarding profile of patients with cerebellar involvement in CVT. We describe the clinical profile, investigations, and outcome of patients with cerebellar involvement with CVT. METHODS: We prospectively studied 6 (male:female: 5:1, mean age 29.3 ± 10.3 years) patients of CVT with cerebellar involvement (2 isolated cerebellar and 4 associated deep or supratentorial structures) among 330 CVT patients (1.8%) admitted in our stroke unit during a period of 3 years. RESULTS: The presenting features (mean duration 7.0 ± 4.7 days) were headache, vomiting, encephalopathy, ataxia, and papilledema. Initial diagnosis considered were neuroinfection in 2 patients, raised intracranial pressure in 2, subarachnoid hemorrhage in 1, and subacute ataxia in 1 patient. Computed tomography (CT) was diagnostic in 3 of 5 patients, whereas magnetic resonance imaging (MRI) and magnetic resonance venography were diagnostic in all; in addition, MRI was superior in detecting new lesions not visualized on CT, in better delineating hemorrhages and in predicting the age of thrombus. Patients were managed medically with anticoagulation, anti-edema, and anti-epileptics and supportive treatment. Two patients underwent posterior fossa decompression. Four patients made complete recovery at the time of discharge and 2 patients died (1 because of brain stem dysfunction and another because of postoperative pneumonia and septicemia). CONCLUSIONS: Cerebellar involvement in CVT is very rare, and high index of suspicion is required for diagnosis. Imaging with CT and MRI will help in confirming the diagnosis. Conventional anticoagulation is effective in treatment. Mortality was 33%, and there was no disability in survivors.
BACKGROUND:Cerebral venous thrombosis (CVT) is a rare form stroke with diverse manifestations. There is very little information available regarding profile of patients with cerebellar involvement in CVT. We describe the clinical profile, investigations, and outcome of patients with cerebellar involvement with CVT. METHODS: We prospectively studied 6 (male:female: 5:1, mean age 29.3 ± 10.3 years) patients of CVT with cerebellar involvement (2 isolated cerebellar and 4 associated deep or supratentorial structures) among 330 CVTpatients (1.8%) admitted in our stroke unit during a period of 3 years. RESULTS: The presenting features (mean duration 7.0 ± 4.7 days) were headache, vomiting, encephalopathy, ataxia, and papilledema. Initial diagnosis considered were neuroinfection in 2 patients, raised intracranial pressure in 2, subarachnoid hemorrhage in 1, and subacute ataxia in 1 patient. Computed tomography (CT) was diagnostic in 3 of 5 patients, whereas magnetic resonance imaging (MRI) and magnetic resonance venography were diagnostic in all; in addition, MRI was superior in detecting new lesions not visualized on CT, in better delineating hemorrhages and in predicting the age of thrombus. Patients were managed medically with anticoagulation, anti-edema, and anti-epileptics and supportive treatment. Two patients underwent posterior fossa decompression. Four patients made complete recovery at the time of discharge and 2 patients died (1 because of brain stem dysfunction and another because of postoperative pneumonia and septicemia). CONCLUSIONS: Cerebellar involvement in CVT is very rare, and high index of suspicion is required for diagnosis. Imaging with CT and MRI will help in confirming the diagnosis. Conventional anticoagulation is effective in treatment. Mortality was 33%, and there was no disability in survivors.