Vein Of Galen Thrombosis: A Report Of 3 Cases And Review Of The Literature

ObjectionCerebral venous thrombosis is a special type of cerebral vessel diseases. Both the mechanism and clinical features are different from arterial thrombosis, so that it is difficult to be diagnosed. Because of its nonspecial clinical symptoms and signs, deep cerebral venous thrombosis which is often accompained with extensive sinus thrombsis is rare to be discovered. Galen of vein (Great cerebral vein), which is an important proportion of cerebral venous system, drain the deep venous blood of the cerebrum. It is reported eleven percent of the cerebra venous thrombosis is the thrombosis of great cerebral vein. As its specific anatomical and physical characters, thrombosis of Galen of vein has its particular features in its happening, development, diagnosis and treatment. The advent of non-invasive brain imaging methods in the 1980s resulted in increased recognition of cerebral venous thrombosis. Before that time, only physicians with a high index of suspicion considered the diagnosis in patients with otherwise unexplained headache, focal deficits, seizures, impaired consciousness, or combinations of these features, and the diagnosis of thrombosis of great cerebral vein could be acknowledged only when the patient had been dead. This paper presents three case reports of thrombosis of great cerebral vein, following it reviews the etiology, clinical symptoms, imaging features, modern approaches to diagnosis, treatment and prognosis. By analyzing and summarizing the clinical symptoms imaging features, diagnosis and treatment of thrombosis of great cerebral vein, at the same time, by reviewing the relative literature, we want to improve the clinical physicians'recognition of the thrombosis of vein of Galen.MethodsWe gathered 3 case reports of thrombosis of vein of Galen, to summarize the processes of happening, clinical symptoms, examinations of CSF, imaging features, treatment and prognosis of this rare seen disease. Combining the literatures we review the overall of thrombosis of great cerebral vein.ResultsTwo of the three patients have an acute since while the third has a subacute since. The main clinical features are headache, vomiting, papilledema, epilepsy, impaired conscious and focal deficits. Disappearance of flow void signal and abnormality of bilateral thalamus and basal ganglia area are found in MRI of all the 3 cases. All of the three patients can be diagnosed by magnetic resonance imaging, magnetic resonance venography and digital subtraction angiography. Thrombosis of straight sinus can be found in all the three cases, transverse sinus and sigmoid sinus thrombosis can be found in two of them. Internal cerebral vein, inferior saggital sinus and unilateral internal jugular vein are all involved in one of the two patients. One of the patients has been cured and restarts his work, another one is still trying to recover to health, remaining some sequel, the last one has been dead after her family dependents gave up the attempt.ConclusionsVein of Galen thrombosis is an important neurological condition, which can cause serious complications if not identified and treated promptly. The clinical manifestations of vein of Galen thrombosis are various, without any idiosyncrasy. Increased intracranial pressure is the main feature of vein of Galen thrombosis, with or without focal signs and symptoms. MRI in conjunction with magnetic resonance venography (MRV) is the most sensitive examination technique. Carrying out CT, MRI, MRV or DSA in time is helpful to identify vein of Galen thrombosis as soon as possible. Early diagnosis and treatment is the most important factor for improving the prognosis of vein of Galen thrombosis. Whether or not hemorrhage has happened, anticoagulation with heparin is the preferred treatment, because it can decrease the happening of death and disability. Following that, the patient should take in warfarin for 3-6 months.