Intracerebral hemorrhage due to cerebral venous thrombosis during posterior cervical decompression and fusion for traumatic cervical cord injury: A case report

RATIONALE: Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that causes venous infarction and intracerebral hemorrhage (ICH) with occlusion of cerebral veins, and its incidence is estimated to be 5 per 1 million people per year, accounting for 0.5% to 1.0% of all strokes. Despite advances in the recognition of CVT, the diagnosis and treatment may be difficult because of the diversity of underlying risk factors. A rare case of ICH due to CVT during surgery is described. PATIENT CONCERNS: A 69-year-old-man presented to our department with a history of paralyzed extremities after a backward fall and head trauma. The patient had a history of pharyngeal cancer treated with neck dissection and radiotherapy. Computed tomography (CT) images showed continuous ossification of the posterior longitudinal ligament (OPLL) at C2–5 levels and a fracture line at the caudal end plate of the C5 body. The diagnosis was traumatic cervical cord injury, so that posterior cervical decompression and fusion was performed. Immediately after surgery, the patient developed an epileptic seizure and the disturbance of consciousness persisted. MR venography and contrast CT images showed absence of flow from the superior sagittal sinus to the transverse sinus. DIAGNOSES: The diagnosis in this case was ICH due to CVT. INTERVENTIONS: The patient was treated with anticoagulation using unfractionated heparin. OUTCOMES: The patient ultimately made a complete recovery from CVT. LESSONS: Although risk factors for CVT are diverse, head and neck injury, patient's position during surgery, and postoperative radical neck dissection for pharyngeal cancer might have been the factors in this case. While the measures to prevent this disease are uncertain, early diagnosis and treatment are needed to avoid serious complications.