Internal jugular, subclavian and brachiocephalic vein thrombosis associated with cerebral venous sinus thrombosis

摘要

Sir,A 23-year-old lady presented on day-12 of postpartum with 3 days history of headache and two episodes of generalized tonic-clonic seizures. Examination revealed bilateral papilledema and mild left-sided hemiparesis. Magnetic resonance imaging and venography showed [Figure 1] extensive thrombosis of superior sagital, bilateral lateral, and straight sinus with right thalamic hyperintensities. She was treated with anticoagulation and anti epileptics and supportive measures. Investigations showed low hemoglobin and hyperhomocysteinemia as risk factors apart from puerperal state. On day-10 of admission, she developed left-sided neck pain and swelling of left upper limb. Computerized tomographic venography [Figure 2] showed thrombosis of left internal jugular (IJV),subclavian (SV), and brachiocephalic veins (BV). She improved with optimization of anticoagulation treatment over the next 10 days.Though there are few reports of IJV thrombosis with cerebral venous thrombosis[1/2); however, involvement of simultaneous three veins (IJV, SV, and BV) has not been reported earlier as per our knowledge.