Trombosi del seno retto con infarto bilaterale del talamo e dei gangli della base causato da una fistola durale artero-venosa

Deep cerebral venous thrombosis are rare and have a poor prognosis. They concur with the occlusion of other cerebral veins o sinuses. Their tipical radiological finding is monolateral cerebral infarct o haemorrhage with edema. We report a case with unusual mechanism that led to thrombosis of the straight sinus. The patient was admitted after four-day history of personality changes. Blood examinations and CT scan were normal. Magnetic risonance imaging revealed severe parenchymal edema bilaterally at the level of thalamus, basal ganglia and part of the internal capsule. Angiography showed thrombosis of the straigth sinus, internal cerebral veins and the vein of Galen and the straigth sinus. Embolization of the fistula was done in order to reduce the pressure gradient. The patient was then treated with heparin 5,000 units subcutaneously twice daily. However, the neurological features deteriorated to progressive tetraparesis and coma within one week, and death 20 days after.