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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(05): 358
DOI: 10.1590/0004-282X20180029
Images in Neurology

Lemierre's syndrome leading to cerebral venous thrombosis

Síndrome de Lemierre como causa de trombose venosa cerebral
Alberto R. M. Martinez
1   Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brasil;
,
Carlos Roberto Martins Jr
1   Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brasil;
,
Lucas N. De Resende
1   Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brasil;
,
Tânia A. M. O. Cardoso
1   Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brasil;
,
Fabiano Reis
2   Universidade de Campinas, Departamento de Radiologia, Campinas SP, Brasil;
,
Marcondes C. França Jr
1   Universidade de Campinas, Departamento de Neurologia, Campinas SP, Brasil;
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A febrile 53-year-old man presented with a severe headache one month post-esophagectomy. Inspection highlighted inflammatory signs in the neck incision. Neurological examination was normal. Cerebrospinal fluid demonstrated increased protein levels (155 mg/dL) and mild pleocytosis (11 cells/mm3) with negative bacterial and fungi cultures. Blood cultures were positive for Streptococcus mitis. Vascular imaging of the head and neck revealed a central venous thrombosis, which together with the laboratory findings, matched the characteristics of Lemierre's syndrome ([Figure]). Lemierre's syndrome is a thrombophlebitis of the internal jugular vein[1] commonly related to an infection[2]. The patient had a good outcome after antibiotic and oral anticoagulant treatment.

Zoom Image
Figure A/B: Sagittal (A) and coronal (B) contrast enhanced computed tomography of the neck revealing thickened and enhanced walls with filling defects in the left internal jugular vein (consistent with thrombosis). It is also possible to note air bubbles inside this vein (arrows). C/D: Axial T1-weighted images after contrast also showing filling defects (arrowheads) in the left transverse sinus (C) and in the superior sagittal sinus (D) compatible with cerebral venous thrombosis.

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Conflict of interest:

There is no conflict of interest to declare.

Support

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Grant #13/01766-7 and #2014/19786-7), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).


  • References

  • 1 Kim BY, Yoon DY, Kim HC, Kim ES, Baek S, Lim KJ et al. Thrombophlebitis of the internal jugular vein (Lemierre syndrome): clinical and CT findings. Acta Radiol. 2013 Nov;54(6):622-7. https://doi.org/10.1177/0284185113481019
  • 2 Farhan A, Shah YA, Ali BT, Mumtaz U, Farooq U. The forgotten disease: Lemierre's syndrome. J Pak Med Assoc. 2016;66(12):1652-5.

Address for correspondence

Marcondes Cavalcante França Jr
Departamento de Neurologia da UNICAMP; Rua Tessália Vieira de Camargo, 126; 13083-887 Campinas SP
Brasil   

Publication History

Received: 02 January 2018

Accepted: 03 February 2018

Article published online:
25 August 2023

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  • References

  • 1 Kim BY, Yoon DY, Kim HC, Kim ES, Baek S, Lim KJ et al. Thrombophlebitis of the internal jugular vein (Lemierre syndrome): clinical and CT findings. Acta Radiol. 2013 Nov;54(6):622-7. https://doi.org/10.1177/0284185113481019
  • 2 Farhan A, Shah YA, Ali BT, Mumtaz U, Farooq U. The forgotten disease: Lemierre's syndrome. J Pak Med Assoc. 2016;66(12):1652-5.

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Zoom Image
Figure A/B: Sagittal (A) and coronal (B) contrast enhanced computed tomography of the neck revealing thickened and enhanced walls with filling defects in the left internal jugular vein (consistent with thrombosis). It is also possible to note air bubbles inside this vein (arrows). C/D: Axial T1-weighted images after contrast also showing filling defects (arrowheads) in the left transverse sinus (C) and in the superior sagittal sinus (D) compatible with cerebral venous thrombosis.