Latet anguis in herba (Snake in the grass)
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Department of Neurology, Lourdes Hospital, Kochi, Kerala, India
A 55-year-old man developed sudden headache and confusion. CT head revealed a 1-2 cm left temporal lobar hematoma. 3 hours later, he deteriorated. A repeat CT demonstrated enlargement of the hematoma with 8-9 mm midline shift and subfalcine herniation. He underwent an emergent decompressive craniectomy. Intra-operatively, a thrombosed vein of Labbe was found over the involved lobe. In retrospect the thrombosed vein was visible on the second CT [Figure - 1]. At follow- up a month later, he had a mild residual sensory aphasia. No etiology could be determined for the venous thrombosis.
The vein of Labbι (inferior anastomotic vein) is the largest anastomotic cerebral vein connecting veins of the sylvian fissure with the transverse sinus.[1] Thrombosis of this vein produces infarction and hemorrhage within the underlying temporal lobe. Rarely is thrombosis of this vein seen on CT scans.
References
1. Rhoton AL Jr. The cerebral veins. Neurosurgery 2002;51:S159-205.(Maramattom Boby Varkey)
A 55-year-old man developed sudden headache and confusion. CT head revealed a 1-2 cm left temporal lobar hematoma. 3 hours later, he deteriorated. A repeat CT demonstrated enlargement of the hematoma with 8-9 mm midline shift and subfalcine herniation. He underwent an emergent decompressive craniectomy. Intra-operatively, a thrombosed vein of Labbe was found over the involved lobe. In retrospect the thrombosed vein was visible on the second CT [Figure - 1]. At follow- up a month later, he had a mild residual sensory aphasia. No etiology could be determined for the venous thrombosis.
The vein of Labbι (inferior anastomotic vein) is the largest anastomotic cerebral vein connecting veins of the sylvian fissure with the transverse sinus.[1] Thrombosis of this vein produces infarction and hemorrhage within the underlying temporal lobe. Rarely is thrombosis of this vein seen on CT scans.
References
1. Rhoton AL Jr. The cerebral veins. Neurosurgery 2002;51:S159-205.(Maramattom Boby Varkey)