Letters to Editor Internal jugular, subclavian and brachiocephalic vein thrombosis associated with cerebral venous sinus thrombosis Sir, A 23‑year‑old lady presented on day‑12 of postpartum with 3 days history of headache and two episodes of generalized tonic‑clonic seizures. Examination revealed bilateral papilledema and mild left‑sided hemiparesis. Magnetic resonance imaging and venography showed [Figure 1] extensive thrombosis of superior sagital, bilateral lateral, and straight sinus with right thalamic hyperintensities. She was treated with anticoagulation and anti epileptics and supportive measures. Investigations showed low hemoglobin and hyperhomocysteinemia as risk factors apart from puerperal state. On day‑10 of admission, she developed left‑sided neck pain and swelling of left upper limb. Computerized tomographic venography [Figure 2] showed thrombosis of left internal jugular (IJV),

subclavian (SV), and brachiocephalic veins (BV). She improved with optimization of anticoagulation treatment over the next 10 days. Though there are few reports of IJV thrombosis with cerebral venous thrombosis[1,2]; however, involvement of simultaneous three veins (IJV, SV, and BV) has not been reported earlier as per our knowledge.

Girish Baburao Kulkarni, Veerendrakumar Mustare, Vinod Varghese Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

References

1. Beer‑Furlan A, de Almeida CC, Noleto G, Paiva W, Ferreira AA, Teixeira MJ. Dural sinus and internal jugular vein thrombosis complicating a blunt head injury in a pediatric patient. Childs Nerv Syst 2013;29:1231‑4. 2. Mittal S, Garg P, Verma S, Bhoriwal S, Aggarwal S. Internal jugular vein thrombosis: An uncommon presentation. Vascular 2013;21:267-9. Access this article online Quick Response Code:

Website: www.neurologyindia.com PMID: *** DOI: 10.4103/0028-3886.121935

Received: 21-08-2013 Review completed: 06-09-2013 Accepted: 13-10-2013 a

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Figure 1: Magnetic resonance imaging of brain T1 axial section (a), T2 sagital section (b) and magnetic resonance venography (c) showing thrombosis of superior sagital bilateral lateral sinus and straight sinus

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Figure 2: Computerised tomographic venography coronal (a,b)  and axial (c,d) showing thrombosis of internal jugular, subclavian, and brachiocephalic veins on left side

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Cerebral pheohyphomycosis: Report of a rare case with review of literature Sir, Pheohyphomycosis is a group of fungal infections characterized by presence of septate pigmented hyphae in the tissues and includes cutaneous, subcutaneous and systemic infections. [1] Central nervous system pheohyphomycosis is very rare and presents with unusual features and is associated with poor prognosis without appropriate treatment.[2] A 65‑year‑old male patient presented with fever and later developed left sided hemiparesis of 1 month duration. Contrast computed tomography (CT) and magnetic resonance imaging showed a ring enhancing lesion in the right frontal lobe [Figure 1]. Excision of Neurology India | Sep-Oct 2013 | Vol 61 | Issue 5

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Internal jugular, subclavian and brachiocephalic vein thrombosis associated with cerebral venous sinus thrombosis.

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