Nakaso K, Shimoda M, Yasui K, Mori M, Wakutani Y, Takeshima T, Nakashima K
Division of Neurology, Faculty of Medicine, Tottori University.
Rinsho Shinkeigaku. 2000 Jun;40(6):617-20.
A 55-year-old man, who had been medicated with carbamazepine, phenobarbital, and sodium valproate for 12 years' duration, presented with severe headache, nausea, and transient diplopia. The neurological examination revealed mild disturbance of consciousness and postural tremor. He also complained of severe continuous headache but no throbbing pain. Enhanced head CT showed empty delta sign and irregular pooling of contrast agent around the superior sagittal sinus. Head MRI did not show the flow void in the superior sagittal sinus. Cerebral angiography demonstrated incomplete occlusion of the superior sagittal sinus and well-developed colateral channels. He was diagnosed having superior sagittal sinus thrombosis, and was placed on anticoagulant and antiplatelet drugs. He did not have any other risk factors such as inflammatory disease, infection, malignancy, and oral contraceptives. However, he had been medicated with some anticonvulsants including carbamazepine, which is known to induce venous thrombosis in the leg. Therefore, the association between superior sagittal sinus thrombosis and long term medication with carbamazepine was suspected. This is the first case report of anticonvulsant-associated cerebral venous thrombosis. It suggests that long-term medication with carbamazepine should be considered to be one of the risk factors for cerebral venous thrombosis.
一名55岁男性，服用卡马西平、苯巴比妥和丙戊酸钠12年，出现严重头痛、恶心和短暂性复视。神经系统检查发现轻度意识障碍和姿势性震颤。他还诉说有严重的持续性头痛，但无搏动性疼痛。增强头颅CT显示空三角征及上矢状窦周围造影剂不规则聚集。头颅MRI未显示上矢状窦内血流信号缺失。脑血管造影显示上矢状窦不完全闭塞及侧支循环良好。他被诊断为上矢状窦血栓形成，并接受抗凝和抗血小板药物治疗。他没有其他危险因素，如炎症性疾病、感染、恶性肿瘤和口服避孕药。然而，他一直在服用包括卡马西平在内的一些抗惊厥药，已知卡马西平可诱发腿部静脉血栓形成。因此，怀疑上矢状窦血栓形成与长期服用卡马西平有关。这是抗惊厥药相关性脑静脉血栓形成的首例病例报告。提示长期服用卡马西平应被视为脑静脉血栓形成的危险因素之一。
