To review the clinical presentation, MRI features, and treatment response of an adolescent patient presenting with extensive Cerebral Venous Thrombosis (CVT)

An 18-year-old girl presented to the emergency room with a 2-week history of worsening headaches, vomiting and blurry vision.  On the day of presentation, her parents found her poorly responsive at home, prompting emergency evaluation. 

On examination, the patient was poorly responsive with fluctuation of her mental status. She answered simple questions when prompted but had no spontaneous language and was inattentive. Her pupils were 2mm and reactive and she had mild finger curling of her left hand without drift.

Initial CT head revealed extensive CVT, primarily affecting the deep venous drainage system, right transverse and sigmoid sinuses as well as the right jugular vein.  Results were confirmed by MRI with gadolinium.

Based on the extent of sinus venous thrombosis, it was decided to perform endovascular treatment in addition to intravenous anticoagulation. The procedure was successful, with evidence of recanalization, reversal of bilateral thalamic and right caudate parenchymal edema seen on initial MRI, and rapid return to normal mental status.

This case demonstrates favorable outcome with early MT in addition to systemic AC in an adolescent patient with extensive and likely life-threatening deep CVT. We suggest that impending deep venous strokes should be treated similarly to large vessel arterial strokes with early MT, rather than reserving MT as the last resort when the standard AC treatment fails.