Pizzi Michael A, Alejos David A, Siegel Jason L, Kim Betty Y S, Miller David A, Freeman William D
Departments of Neurology, Mayo Clinic, Jacksonville, Florida; Department of Critical Care, Mayo Clinic, Jacksonville, Florida.
Department of Critical Care, Mayo Clinic, Jacksonville, Florida.
J Stroke Cerebrovasc Dis. 2016 Sep;25(9):2312-6. doi: 10.1016/j.jstrokecerebrovasdis.2016.05.025. Epub 2016 Jun 16.
Cerebral venous thrombosis (CVT) is a rare cerebrovascular event that can present with headache, seizure, and focal neurological deficits. Approximately 30%-40% of patients with CVT also present with intracranial hemorrhage. Current guidelines recommend anticoagulation after CVT even in the setting of intracranial hemorrhage, but the timing of initiation is unclear. We present a case of CVT where timing of anticoagulation was unclear by current guidelines.
We conducted a literature search with search terms of "cerebral venous thrombosis," "intracranial hemorrhage," and "anticoagulation." Abstracted information included anticoagulation status and time of initiation of anticoagulation. We present a 30-year-old woman with sudden onset of right hemiplegia, global aphasia, and new-onset seizures diagnosed with left transverse and sigmoid sinus thrombosis with intraparenchymal hemorrhage. The patient was treated with endovascular thrombectomy and decompressive hemicraniectomy due to hemorrhage expansion, and anticoagulation was restarted 8 days after hemicraniectomy.
The literature review demonstrated a wide variation of timing for anticoagulation initiation in patients with CVT and intracranial hemorrhage. Most started anticoagulation within 24 hours of admission with similar functional neurological recovery. Current guidelines on the treatment of CVT, even with intracranial hemorrhage, recommend anticoagulation. Most reports in the literature state initiation of anticoagulation within 24 hours. However, the literature does not definitively state when to initiate anticoagulation in a patient with CVT, intracranial hemorrhage, thrombectomy, and decompressive hemicraniectomy.
This case illustrates the challenge of determining when to resume anticoagulation for CVT.
脑静脉血栓形成（CVT）是一种罕见的脑血管事件，可表现为头痛、癫痫发作和局灶性神经功能缺损。约30%-40%的CVT患者还伴有颅内出血。目前的指南建议即使在颅内出血的情况下，CVT患者也应进行抗凝治疗，但开始抗凝的时机尚不清楚。我们报告一例CVT病例，目前的指南对其抗凝时机并不明确。
我们以“脑静脉血栓形成”、“颅内出血”和“抗凝”为检索词进行了文献检索。提取的信息包括抗凝状态和开始抗凝的时间。我们报告一名30岁女性，突发右侧偏瘫、完全性失语和新发癫痫发作，诊断为左侧横窦和乙状窦血栓形成并伴有脑实质内出血。由于出血扩大，患者接受了血管内血栓切除术和减压性颅骨切除术，并在颅骨切除术后8天重新开始抗凝治疗。
文献综述表明，CVT合并颅内出血患者开始抗凝的时间差异很大。大多数患者在入院后24小时内开始抗凝，神经功能恢复情况相似。目前关于CVT治疗的指南，即使是在伴有颅内出血的情况下，也建议进行抗凝治疗。文献中的大多数报告称在24小时内开始抗凝。然而，文献并未明确指出在CVT、颅内出血、血栓切除术和减压性颅骨切除术患者中何时开始抗凝。
本病例说明了确定CVT何时恢复抗凝治疗的挑战。
