London, United Kingdom 2013 E-Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 269 5 Interesting and challenging cases THREE VERY CHALLENGING CASES OF DEEP VENOUS THROMBOSIS R. FAHED1, A. DUMITRANA2, C. LESOIL3, S. KOSSI4, H. HOSSEINI5 Hôpital Henri-Mondor - Service de Neurologie du Pr. CESARO - Unvité Neurovasculaire de Dr. HOSSEINI, CRETEIL, FRANCE1, Hôpital Henri-Mondor - Service de Neurologie du Pr. CE-SARO - Unvité Neurovasculaire de Dr. HOSSEINI, CRETEIL, FRANCE2, Hôpital Henri-Mondor - Service de Neurologie du Pr. CESARO, CRETEIL, FRANCE3, Hôpital Henri-Mondor - Service de Neurologie du Pr. CESARO, CRETEIL, FRANCE4, Hôpital Henri-Mondor - Service de Neurologie du Pr. CESARO - Unvité Neurovasculaire, CRETEIL, FRANCE5 BACKGROUND: Cerebral venous thrombosis can manifest in various clinical forms, especially when concerning the deep venous system causing bithalamic lesions. We report three observations of patients which had a deep venous thrombosis with a bithalamic infarction, and an original clinical presentation. METHODS: A 57 years old man was suffering from psychomotor slowing since 3 months. In 2 days, he presented aphasia and apraxia. His brain CT was normal, and his MRI showed a bithalamic hypersignal in T2 with peripheral contrast enhancing. His first diagnosis was a brain tumor. A 36 years old man was found in his apartment with major psychomotor slowing, confusion and memory loss. Because he had a known depression, he was first diagnosed a melancholic depression. A 42 years old bipolar woman was hospitalized because of a severe confusion and psychomotor slowing. Her neurological exam was normal. Her diagnosis was a depression relapse. RESULTS: The first patient had a biopsy which showed a reactive gliosis without tumoral prolifer-ation. A phlebography revealed a venous thrombosis of the straight sinus. The patient which a sus-pected melancholic depression had a MRI which showed an asymmetric Bithalamic hemorrhagic infarction. The phlebography revealed a deep venous thrombosis. An as-sessment of thrombophilia showed a heterozygous factor II G 20210 A mutation. The bipolar woman had a MRI which also showed an asymmetric bithalamic hemorrhagic infarc-tion. Her phlebography also revealed a deep venous thrombosis. All three clinical evolutions were favourable under anticoagulant treatment and rehabilitation CONCLUSION: Bithalamic lesions can look like tumor on a brain imaging, and can be revealed by several symptoms, including pseudopsychiatric ones. Physicians must always keep in mind a cere-bral venous thrombosis when discovering a bithalamic lesion. Keywords: Tumor - Cerebral Venous thrombosis- Thalamus- Pseudopsychiatric- MRI.
Karger_ESC London_2013
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