Three Cases of Cerebral Venous Thrombosis with Rehabilitation / The Japanese Journal of Rehabilitation Medicine

ABSTRACT

Cerebral venous thrombosis(CVT)is a rare cerebrovascular disorder. However, many reports have suggested that the prognosis of CVT is better than arterial ischemic infarction accompanied with cytotoxic edema. In this report, we present three cases of CVT to explain the possible effectiveness of using a rehabilitation approach. Case 1 was a 51-year-old female oculist with amnestic aphasia and mild right hemiparesis. MRI revealed a massive edematous lesion in the left basal ganglia and thalamus, due to thrombus in the vein of Galen. Speech therapy to facilitate word recall showed remarkable benefit, sufficient enough for her to return to work. Case 2 was a 68-year-old male tax accountant with fluent aphasia. MRI showed multiple contrast-enhanced lesions in his left temporal lobe, due to a lack of venous flow in the left transverse sinus. Speech therapy was also effective enough for him to return to work at 35 days after onset. Case 3 was a 57-year-old male pilot. He suddenly presented severe generalized convulsions controlled by venous anesthetic under mechanical ventilation, due to CVT in the superior sagittal sinus with bilateral frontal hemorrhagic infarction. After extubation, he was transferred to our hospital at 38 days after the disease onset, presenting frontal lobe dysfunction, including apathy, emotional incontinence, and grasp reflexes. During 43 hospitalization days, physical and occupational therapy resulted in drastic improvement in this patient's Barthel index score, from 0 to 50. In conclusion, an early rehabilitation approach should be recommended for CVT, since a better prognosis can be anticipated than in arterial ischemic infarction, regardless of the severity of original brain damage.