COMPUTED TOMOGRAPHIC EVIDENCE OF AN EXTENSIVE THROMBOSIS AND INFARCTION OF THE DEEP VENOUS SYSTEM

Background. Massive bilateral infarcts due to deep venous system throm bosis are extremely rare and poorly documented. We present a case with computed tomographic evidence of both thrombosis and infarction of th e whole deep venous system. Case Description: A previously healthy 30- year-old woman who had taken oral contraceptives for 3 years complaine d of recurrent headaches and transient visual obscuration. Three month s later, she suddenly became comatose and was found to have papilledem a. She rapidly worsened, became decerebrate, and died within 48 hours. Noncontrast computed tomographic scan showed the spontaneous hyperden sity of the thrombosed deep veins and a massive bilateral centrobasila r hypodensity suggestive of a deep venous system infarction. Conclusio ns. This case shows that cerebral venous thrombosis can masquerade dur ing 3 months as benign intracranial hypertension and then make a drama tic extension to the deep cerebral veins. It illustrates extensive thr ombosis of the deep venous system as a possible cause of rapid coma an d decerebration and stresses the importance of computed tomographic sc an to show both the thrombosed veins and the venous infarct, which all ows delineation of the deep venous system territory.