• Haiyan Zheng, Weilin Xu, Yili Chen, Shiying Gai, and Gao Chen.
• Department of Neurosurgery, Fourth Affiliated Hospital, Yiwu Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
• Medicine (Baltimore). 2018 Sep 1; 97 (36): e11587e11587.

RationaleDeep cerebral venous thrombosis (DCVT) is a rare disease, but always results in poor prognosis.Patient ConcernsWe reported a 79-year-old female with coma after traumatic brain injury (TBI).DiagnosisThe epidural hematoma was first diagnosed on non-contrast computerized tomography (CT). The hypodense areas in bilateral thalami and basal ganglia on reexamination CT highly indicated the suspicion of DCVT. Finally, the appearance of thrombosis of the vein of Galen on the computed tomography venography (CTA) and digital subtraction angiography (DSA) confirmed the diagnosis.InterventionsThe patients received surgery to remove the epidural hematoma. After that, she was treated with oral anticoagulation agent (low molecular weight heparin (LMWH), 180 Axal U/kg 24 h) for 4 weeks, shifted by oral warfarin (2.5 mg qd) for 4 weeks.OutcomesThe hypodense areas in bilateral thalami and basal ganglia have been largely reversed. At the time of 6 months after surgery, the patient could take care of herself.LessonsIf the CT shows hypodense areas in bilateral thalami and basal ganglia, a diagnosis of DCVT should be suspected once the patients could not recover from the treatment of primary diseases.

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