Zerebrale Sinus/-Venenthrombose durch zervikale Lymphadenopathie mit Jugularvenenkompression bei akuter EBV-Infektion

Zusammenfassung

Wir berichten über eine 23-jährige Patientin, die sich in unserer Klinik aufgrund einer akut aufgetretenen, schweren Wesensveränderung sowie seit mehreren Wochen bestehender Cephalgien und fieberhaftem Infekt vorstellte. Als Ursache zeigte sich eine äußere und innere zerebrale Sinus/-Venenthrombose, welche auf eine venöse Drainagebehinderung bei Kompression der V. jugularis interna links durch eine ausgeprägte zervikale Lymphadenopathie bei Pfeifferschem Drüsenfieber (Epstein-Barr-Virus-Infektion) zurückzuführen war. Unter Therapie mit niedermolekularem Heparin bildete sich die Symptomatik weitgehend zurück.

Abstract

Cerebral venous sinus thromboses (CVST) are a common differential diagnosis in patients complaining about acute or chronic headache. We present the case of a 23-year-old female patient with severe CVST due to jugular vein compression causing obstruction of venous drainage with pronounced cervical lymphadenopathy due to acute infection with Epstein-Barr virus (kissing disease). The clinical symptoms of fever, headache, severe psychomotor slowing and apathy improved under therapeutic anticoagulation with low molecular weight heparin.

Schlüsselwörter

zerebrale Sinus/-Venenthrombose - Sinusthrombose - Pfeiffersches Drüsenfieber - Epstein-Barr-Virus - Wesensveränderung

Keywords

cerebral venous sinus thrombosis - mononucleosis - Epstein-Barr virus - personality change

• Literatur

• 1 Ferro J, Correia M, Pontes C. et al. Cerebral vein and dural sinus thrombosis in Portugal: 1980-1998. Cerebrovasc Dis 2001; 11: 177-182
• 2 Geisbüsch C, Richter D, Herweh C. et al. Novel factor Xa inhibitor for the treatment of cerebral venous and sinus thrombosis: first experience in 7 patients. Stroke 2014; 45: 2469-2471
• 3 Amici S. Thalamic infarcts and hemorrhages. Front Neurol Neurosci 2012; 30: 132-136
• 4 Masuhr F, Busch M, Amberger N. et al. Risk and predictors of early epileptic seizures in acute cerebral venous and sinus thrombosis. Eur J Neurol 2006; 13: 852-856
• 5 Biousse V, Ameri A, Bousser M. Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology 1999; 53: 1537-1542
• 6 Ferro J, Falcao F, Meio T. et al. Dural sinus thrombosis mimicking “capsular warning syndrome”. J Neurol 2000; 247: 802-803
• 7 Ferro JM, Canhão P, Stam J. et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35: 664-670
• 8 Coutinho JM, Stam J, Canhão P. et al. Cerebral venous thrombosis in the absence of headache. Stroke 2015; 46: 245-247
• 9 Saposnik G, Barinagarrementeria F, Brown RD. et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42: 1158-1192
• 10 Lauw MN, Barco S, Coutinho JM. et al. Cerebral venous thrombosis and thrombophilia: A systematic review and meta-analysis. Semin Thromb Hemost 2013; 39: 913-927
• 11 Schievink W, Mayam M. Cerebral venous thrombosis in spontaneous intracranial hypotension. Headache 2008; 48: 1511-1519
• 12 Pfeilschifter W, Neumann-Haefelin T, Hattingen E. et al. Kortikale Venenthrombose nach diagnostischer Lumbalpunktion. Nervenarzt 2009; 80: 1219-1221
• 13 Arauz A, Vargas-Gonzalez J-C, Arguelles-Morales N. et al. Time to recanalisation in patients with cerebral venous thrombosis under anticoagulation therapy. J Neurol Neurosurg Psychiatry 2016; 87: 247-251
• 14 Martinelli I, Bucciarelli P, Passamonti SM. et al. Long-term evaluation of the risk of recurrence after cerebral sinus-venous thrombosis. Circulation 2010; 121 (25) 2740-2746
• 15 Weimar C (federführend). DGN-Leitlinie: Zerebrale Sinus- und Venenthrombose. 2012 https://www.dgn.org/leitlinien/2320-ll-29-2012-zerebrale-sinus-und-venenthrombose
• 16 Leach J, Fortuna R, Jones B. et al. Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics 2006; 26 (Suppl. 01) 19-41
• 17 Agid R, Shelef I, Scott J. et al. Imaging of the intracranial venous system. Neurologist 2008; 14: 12-22
• 18 Chu K, Kang DW, Yoon BW. et al. Diffusion-weighted magnetic resonance in cerebral venous thrombosis. Arch Neurol 2001; 58: 1569-1576
• 19 Cakmak S, Hermier M, Montavont A. et al. T2*-weighted MRI in cortical venous thrombosis. Neurology 2004; 63: 1698
• 20 Dentali F, Squizzato A, Marchesi C. et al. D-dimer testing in the diagnosis of cerebral vein thrombosis: a systematic review and a meta-analysis of the literature. J Thromb Haemost 2012; 10: 582-589
• 21 Misra U, Kalita J, Chandra S. et al. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. Eur J Neurol 2012; 19: 1030-1036
• 22 Coutinho JM, Ferro JM, Canhão P. et al. Unfractionated or low-molecular weight heparin for the treatment of cerebral venous thrombosis. Stroke 2010; 41: 2575-2580
• 23 Boehringer Ingelheim Pharma GmbH & Co. KG. RE-SPECT CVT. a randomised, open-label, exploratory trial with blinded endpoint adjudication (PROBE), comparing efficacy and safety of oral dabigatran etexilate versus oral warfarin in patients with cerebral venous and dural sinus thrombosis over a 24-wee [Internet]. EudraCT. Nr. 2015-004412-382017; [cited 2017 Jun 5] Available from: https://www.clinicaltrialsregister.eu/ctr-search/trial/2015-004412-38/DE