Journal List > Korean J Leg Med > v.39(1) > 1087962

Korean J Leg Med. 2015 Feb;39(1):22-26. Korean.
Published online February 28, 2015.
© Copyright 2015 by the Korean Society for Legal Medicine
Death due to Pulmonary Thromboembolism with Cerebral Venous Thrombosis
Joo-Young Na,1 Jeong-Woo Park,1 Yeon-Ho Oh,1 Kyung-Wook Kang,2 Jong-In Na,3 Hyung-Seok Kim,3 and Jong-Tae Park3
1Forensic Medicine Division, Gwangju Institute, National Forensic Service, Jangseong, Korea.
2Department of Neurology, Chonnam National University Medical School, Gwangju, Korea.
3Department of Forensic Medicine, Chonnam National University Medical School, Gwangju, Korea.

Correspondence to Joo-Young Na. Forensic Medicine Division, Gwangju Institute, National Forensic Service, 687 Chungnyeong-ro, Seosam-myeon, Jangseong 515-822, Korea. Tel: +82-61-393-8442, Fax: +82-61-393-8440, Email:
Received January 26, 2015; Revised January 30, 2015; Accepted February 12, 2015.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.

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


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

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.
Click for larger image

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).
Click for larger image


No potential conflict of interest relevant to this article was reported.

1. Saposnik G, Barinagarrementeria F, Brown RD Jr, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:1158–1192.
2. Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol 2007;6:162–170.
3. Towbin A. The syndrome of latent cerebral venous thrombosis: its frequency and relation to age and congestive heart failure. Stroke 1973;4:419–430.
4. Ferro JM, Canhao P, Stam J, et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004;35:664–670.
5. Biousse V, Ameri A, Bousser MG. Isolated intracranial hypertension as the only sign of cerebral venous thrombosis. Neurology 1999;53:1537–1542.
6. Gulati D, Strbian D, Sundararajan S. Cerebral venous thrombosis: diagnosis and management. Stroke 2014;45:e16–e18.
7. Diaz JM, Schiffman JS, Urban ES, et al. Superior sagittal sinus thrombosis and pulmonary embolism: a syndrome rediscovered. Acta Neurol Scand 1992;86:390–396.