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Cerebral venous thrombosis (CVT) is one cause of stroke presenting with variable symptoms, mainly caused by individual variations in the cerebral venous drainage. Involvement of the deep venous system is associated with a poor prognosis.1 Despite anticoagulant treatment,2 some patients continue to deteriorate. In such cases, the local administration of thrombolytic agents into the cerebral venous system has been reported.3
We report a patient with extensive deep CVT who was treated with intra-arterial infusion of recombinant tissue plasminogen activator (rt-PA) into both internal carotid arteries and the left vertebral artery. A complete resolution of the thrombus resulted, and clinical recovery was excellent.
Case report.
A 49-year-old man was treated with oral anticoagulation for a hereditary antithrombin (AT-III) deficiency, which had previously led to a thrombosis of the superior sagittal sinus at age 30 years and a pulmonary embolism at age 43 years. Anticoagulation was discontinued 4 weeks before symptom onset because of scheduled dental work. The day before admission the patient had headache and decreasing level of consciousness. On admission, he was stuporous, had slurred speech, severe hemiparesis, and multimodal hemineglect on the left side. The level of d-dimer was increased to 30.3 μg/mL, and AT-III activity was …
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