Recurrent Idiopathic Cerebral Venous Thrombosis

A 40-year-old female with a past medical history of beta thalassemia minor presented to the ED with an intractable headache, nausea, and vomiting. A CT head without IV contrast was performed that was negative for any signs of subarachnoid hemorrhage, or thrombotic etiology. The patient presented 48 hours later and was found to have cerebral venous thrombosis (CVT). She was subsequently taken for mechanical thrombectomy. Despite mechanical thrombectomy, her intracranial pressure (ICP) continued to rise. The patient underwent neurosurgical intervention with placement of external ventricular drain (EVD). Despite EVD placement, pressure continued to rise intracranially. The patient then went for a repeat thrombectomy, which was unsuccessful as clots continued to reaccumulate. No existing tool or measurement can lead to better outcomes regarding CVT cases. It is possible that with improved imaging modalities, early diagnosis is possible with high clinical suspicion, but further data needs to be collected. Per our literature review, there is no existing data regarding reaccumulating of clot burden despite intervention. This case represents the need for a broader discussion about risk stratification to identify quantifiable measures for better patient outcomes.