Diagnosis and Management of Cerebral Venous Thrombosis Due to Polycythemia Vera and Genetic Thrombophilia: Case Report and Literature Review
Dragos Catalin Jianu,
Silviana Nina Jianu,
Nicoleta Iacob,
Traian Flavius Dan,
Georgiana Munteanu,
Anca Elena Gogu,
Raphael Sadik,
Andrei Gheorghe Marius Motoc,
Any Axelerad,
Carmen Adella Sirbu,
Ligia Petrica,
Ioana Ionita
Affiliations
Dragos Catalin Jianu
First Division of Neurology, Department of Neurosciences VIII, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
Silviana Nina Jianu
Department of Ophthalmology, “Dr. Victor Popescu” Military Emergency Hospital, 7 G. Lazar Ave., 300080 Timisoara, Romania
Nicoleta Iacob
Department of Multidetector Computed Tomography and Magnetic Resonance Imaging, Neuromed Diagnostic Imaging Centre, 300218 Timisoara, Romania
Traian Flavius Dan
First Division of Neurology, Department of Neurosciences VIII, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
Georgiana Munteanu
First Division of Neurology, Department of Neurosciences VIII, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
Anca Elena Gogu
First Division of Neurology, Department of Neurosciences VIII, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
Raphael Sadik
Department of Geriatrics-Rehabilitation, Riviera-Chablis Hospital, 3 Prairie Ave., 1800 Vevey, Switzerland
Andrei Gheorghe Marius Motoc
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, “Victor Babes” University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Any Axelerad
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, “Victor Babes” University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Carmen Adella Sirbu
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, “Victor Babes” University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Ligia Petrica
Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), Department of Neurosciences VIII, “Victor Babes” University of Medicine and Pharmacy, 156 L. Rebreanu Ave., 300736 Timisoara, Romania
Ioana Ionita
Division of Hematology, Department V, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Sq., No. 2, 300041 Timisoara, Romania
(1) Background: Cerebral venous and dural sinus thrombosis (CVT) rarely appears in the adult population. It is difficult to diagnosis because of its variable clinical presentation and the overlapping signal intensities of thrombosis and venous flow on conventional MR images and MR venograms. (2) Case presentation: A 41-year-old male patient presented with an acute isolated intracranial hypertension syndrome. The diagnosis of acute thrombosis of the left lateral sinus (both transverse and sigmoid portions), the torcular Herophili, and the bulb of the left internal jugular vein was established by neuroimaging data from head-computed tomography, magnetic resonance imaging (including Contrast-enhanced 3D T1-MPRAGE sequence), and magnetic resonance venography (2D-TOF MR venography). We detected different risk factors (polycythemia vera-PV with JAK2 V617F mutation and inherited low-risk thrombophilia). He was successfully treated with low-molecular-weight heparin, followed by oral anticoagulation. (3) Conclusions: In the case of our patient, polycythemia vera represented a predisposing risk factor for CVT, and the identification of JAK2 V617F mutation was mandatory for the etiology of the disease. Contrast-enhanced 3D T1-MPRAGE sequence proved superior to 2D-TOF MR venography and to conventional SE MR imaging in the diagnosis of acute intracranial dural sinus thrombosis.
