|How to cite this article:
Srivastava T, Nagpal K. Deep cerebral vein thrombosis in a case of breast carcinoma. Ann Trop Med Public Health 2013;6:593-4
|How to cite this URL:
Srivastava T, Nagpal K. Deep cerebral vein thrombosis in a case of breast carcinoma. Ann Trop Med Public Health [serial online] 2013 [cited 2017 Nov 14];6:593-4. Available from: https://www.atmph.org/text.asp?2013/6/5/593/133772
Deep cerebral venous thrombosis (DCVT) is a rare, potentially fatal disease. DCVT is mainly due to hypercoagulable state seen in the use of oral contraceptive drugs, Behcet syndrome and nephrotic syndrome and as paraneoplastic syndrome in malignant diseases. Literature reports of DCVT, less than 10 cases are evoked by malignant disease.  We report a case of breast carcinoma, who developed DCVT.
A 52-year-old lady developed breast carcinoma and operated. She was treated with adriamycin, 5-fluorouracil and cyclophosphamide. Three months after the operation, one day she suddenly became deeply comatose. There was no history of seizure. Patient was only responding to deep painful stimuli. Glasgow coma scale was 5. There was no focal neurological deficit or signs of meningeal irritation. Brain contrast enhanced computed tomography scan revealed hypodensity in the bilateral basal ganglion and thalami [Figure 1]a, obstructive hydrocephalus and internal cerebral vein thrombosis [Figure 1]b suggestive of deep cerebral vein thrombosis. She was treated with intravenous heparin infusion. Brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) and cerebral digital subtraction angiography (DSA) could not be performed as her condition worsened rapidly and she died within 13 h.
The diagnosis of DCVT should be strongly suspected, if the infarct is within the basal ganglia or thalamus and especially if it is bilateral. It is due to obliteration of thalamostriate veins, internal cerebral veins and the great vein of Galen.  DCVT can be diagnosed by brain computed tomography, MRI, computed tomography angiography, MRA and DSA.  The course of disease is aggressive, the prognosis is poor and even if the patients survive considerable neurological deficits may remain. Therapeutic options for DCVT are systemic anti-coagulant therapy and local infusion of tissue plasminogen activator. 
|Figure 1: (a) Brain contrast enhanced computed tomography (CECT) scan shows bilateral low density changes in the basal ganglion (arrowhead of large arrow). Mass effect from edematous thalami (arrowhead of small arrow) has caused obstructive hydrocephalus. (b) Brain CECT scan shows obscuration of the borders between lentiform nuclei, thalami and internal capsules (arrow head of small arrow) and thrombosis of internal cerebral vein (arrow head of large arrow)
Click here to view
Pregnancy, puerperium, oral contraceptive use and infections are the most common predisposing factors. Malignancy is one of the etiological factors for cerebral venous thrombosis. , Literature reports around 50 cases of DCVT, of which less than 10 were evoked by malignant disease.  This is the first case report of DCVT in case of breast carcinoma in Indian scenario. Hypercoagulable state due to malignancy or paraneoplastic syndrome may be responsible for DCVT. The symptoms of DCVT can mimic cerebral metastases in cancer patients. The possibility of DCVT must be taken into account if sudden neurological symptoms develop in a cancer patient.
|1.||Tóth L, Szakáll S, Káposzta Z, Udvardy M. Cerebral deep vein thrombosis associated with rectal cancer. Orv Hetil 2000;141:2493-6.|
|2.||Sagduyu A, Sirin H, Mulayim S, Bademkiran F, Yunten N, Kitis O, et al. Cerebral cortical and deep venous thrombosis without sinus thrombosis: Clinical MRI correlates. Acta Neurol Scand 2006;114:254-60.|
|3.||Lafitte F, Boukobza M, Guichard JP, Reizine D, Woimant F, Merland JJ. Deep cerebral venous thrombosis: Imaging in eight cases. Neuroradiology 1999;41:410-8.|
|4.||Yamini B, Loch Macdonald R, Rosenblum J. Treatment of deep cerebral venous thrombosis by local infusion of tissue plasminogen activator. Surg Neurol 2001;55:340-6.|
|5.||Ferro JM, Canhão P, Bousser MG, Stam J, Barinagarrementeria F, ISCVT Investigators. Cerebral vein and dural sinus thrombosis in elderly patients. Stroke 2005;36:1927-32.|
|6.||López-Peláez MF, Millán JM, de Vergas J. Fatal cerebral venous sinus thrombosis as major complication of metastatic cervical mass: Computed tomography and magnetic resonance findings. J Laryngol Otol 2000;114:798-801.|
Source of Support: None, Conflict of Interest: None