Abstract
A 16-year-old male was admitted to our hospital with fever, headache, recurrent general convulsion, and consciousness disturbance. A cerebrospinal fluid (CSF) examination revealed increased CSF pressure but no other abnormal findings. Diffusion-weighted MRI revealed a blurred high intensity area without a reduction in the apparent diffusion coefficient in both parietal lobes. The anterior half of the superior sagittal sinus was not shown by angiography and MR venography, and coagulation studies revealed a considerably decreased antithrombin (AT) III value. He was diagnosed with cerebral venous thrombosis (CVT) derived from an ATIII deficiency. Because systemic anticoagulation and anticonvulsant therapy were ineffective, intraarterial thrombolytic therapy using urokinase was administered, but no dissolution of the clot was achieved. Mechanical clot disruption was performed as a secondary treatment using a percutaneous transluminal angioplasty (PTA) balloon catheter, and recanalization was achieved. Anticoagulation therapy with heparin and an AT agent was performed subsequently, and the patient recovered without sequelae. After 2 months, MRI revealed nothing abnormal except a microbleed in the right parietal lobe. Systemic anticoagulation with heparin is thought to be a standard therapy in CVT, but managing patients with ATIII deficiency is difficult because heparin is not effective in a low ATIII environment. Our experience suggests that PTA is an effective treatment for CVT, especially in patients with hemostatic abnormalities. Early diagnosis and appropriate intervention prevent a poor prognosis for CVT.
