Richard Sébastien, Lacour Jean-Christophe, Frotscher Birgit, Enea Ana, Mione Gioia, Ducrocq Xavier
Department of Neurology, University Hospital of Nancy, Hopital Central, 29 avenue du Marechal de Lattre de Tassigny-CO n, Nancy Cedex, 34 54035, France.
BMC Neurol. 2014 Sep 22;14:182. doi: 10.1186/s12883-014-0182-3.
Reports of occurrence of deep vein thrombosis during intensive sport are scarce. While a few cases have been described in the cerebral territory, these are only in the context of traumatism or anabolic agent consumption. Thus, causality with exercise remains uncertain and the mechanisms hypothetic. We present the case of a young athlete who experienced two episodes of severe cerebral venous thromboses (CVT), both during intensive training, in the absence of any other known thrombogenic factor.
A healthy 26-year-old man presented a thrombosis of the superior sagittal sinus during recent intensive training for a triathlon. Investigation at the time found no drug or anabolic steroid consumption, or any hematologic or coagulation disturbance. Anticoagulation therapy was initiated for 10 months with good outcome. One year later, soon after returning to intensive exercise, mainly running, the patient presented a thrombosis of the straight sinus complicated by bithalamic hyperintensities observed on T2 magnetic resonance imaging sequences. Anticoagulation treatment was reinitiated and led to repermeabilization of the cerebral vein and reversibility of thalamic abnormalities. Four months later, the patient was free of headache and had no cognitive impairment. He continues to practice intensive sport with vitamin K antagonist as preventive treatment.
This is the first case report of recurrent CVT in a context of intensive sport, without any other thrombogenic features, suggesting a causal link. Intensive exercise should be considered as a potential promoting factor of CVT and investigated during routine examination.
关于在高强度运动期间发生深静脉血栓形成的报道很少。虽然在脑区已有少数病例被描述，但这些仅发生在创伤或使用合成代谢药物的背景下。因此，与运动的因果关系仍不确定，其机制也只是推测性的。我们报告了一名年轻运动员的病例，该运动员在没有任何其他已知血栓形成因素的情况下，在高强度训练期间经历了两次严重的脑静脉血栓形成（CVT）发作。
一名健康的26岁男性在最近一次铁人三项强化训练期间出现上矢状窦血栓形成。当时的调查未发现使用药物或合成代谢类固醇，也未发现任何血液学或凝血障碍。开始进行了10个月的抗凝治疗，效果良好。一年后，在重新开始主要是跑步的高强度运动后不久，患者出现直窦血栓形成，并伴有T2磁共振成像序列上观察到的双侧丘脑高信号。再次开始抗凝治疗，导致脑静脉再通和丘脑异常可逆。四个月后，患者头痛消失，无认知障碍。他继续进行高强度运动，并使用维生素K拮抗剂作为预防性治疗。
这是第一例在高强度运动背景下反复发生CVT的病例报告，且无任何其他血栓形成特征，提示存在因果关系。高强度运动应被视为CVT的潜在促发因素，并在常规检查中进行调查。
