Korean J Leg Med.  2015 Feb;39(1):22-26. 10.7580/kjlm.2015.39.1.22.

Death due to Pulmonary Thromboembolism with Cerebral Venous Thrombosis

• Na JY
• Park JW
• Oh YH
• Kang KW
• Na JI
• Kim HS
• Park JT

• KMID: 1785235
• DOI: http://doi.org/10.7580/kjlm.2015.39.1.22

Abstract

Cerebral venous thrombosis is an uncommon cause of cerebral infarction. A 31-year-old man complained of headache, weakness, and numbness of the left leg a day before being admitted to the hospital. After admission, brain computed tomography and brain magnetic resonance imaging revealed superior sagittal sinus thrombosis with cerebral infarction in the right hemisphere. He had no significant medical history. On the fourth hospital day, he suddenly collapsed and died. Medicolegal autopsy was performed 3 days later; medical malpractice was suspected. External examination revealed a few conjunctival petechiae. Internal examination revealed thrombi in the superior sagittal sinus and superficial cortical veins. Thrombi were noted in the pulmonary trunk and both pulmonary arteries. Upon dissection of the left leg, we found thrombi in the posterior tibial vein. A microscopic examination revealed vasculitis of the same cortical veins, and we therefore assumed that vasculitis of the cortical veins gave rise to thrombosis. In typical autopsy practice, an examination of the dura mater is often overlooked, but careful examination of this region should be performed in cases of cerebral infarction in young adults, such as this one.

Keyword

Intracranial thrombosis; Venous thrombosis; Pulmonary embolism; Vasculitis; Autopsy

MeSH Terms

Adult
Autopsy
Brain
Cerebral Infarction
Dura Mater
Headache
Humans
Hypesthesia
Intracranial Thrombosis
Leg
Magnetic Resonance Imaging
Malpractice
Pulmonary Artery
Pulmonary Embolism*
Purpura
Superior Sagittal Sinus
Thrombosis
Vasculitis
Veins
Venous Thrombosis*
Young Adult

Figure

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  Fig. 1. T1-weighted magnetic resonance image shows cord-like hyperintensity signals (arrow) representing a venous thrombosis of the superior sagittal sinus.

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  Fig. 2. (A) A brain side of the dura mater shows multiple thrombi in the superior sagittal sinus and cortical veins. (B) A thrombus is noted in the pulmonary trunk and both pulmonary arteries. (C) A deep vein thrombosis in the left leg is noted.

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  Fig. 3. (A) A blood clot with fibrin is noted in the lumen of the cortical vein (H&E, ×50). (B) A vasculitis of the cortical vein is noted (H&E, ×200).

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