Chatterjee Subhankar, Sharma Chandra Bhushan, Guria Rishi Tuhin, Dubey Souvik, J Lavie Carl
Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
Department of Neurology, Bangur Institute of Neurosciences, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
J Family Med Prim Care. 2020 Apr 30;9(4):2107-2110. doi: 10.4103/jfmpc.jfmpc_192_20. eCollection 2020 Apr.
Cerebral venous sinus thrombosis (CVT) is notoriously known for its varied presentations and extremely high risk of mortality, if remains undetected and untreated. On the other hand, life can be saved with full functional recovery if CVT can be identified with high index of clinical suspicion with supportive imaging and treatment with appropriate anticoagulation. It is important for clinicians to be meticulous to screen for both the potential reversible and heritable causes of CVT so that appropriate measures can be taken to prevent such catastrophe. Here we report a case of CVT involving right sigmoid and transverse sinuses presenting with acute onset left sided hemiplegic without antecedent headache or seizures. Patient was successfully treated with anticoagulants with nearly full functional recovery. Multiple predisposing factors were identified. As per our knowledge, this is the first case of CVT with underlying conglomeration of multiple acquired (lactation, folate deficiency, hyperhomocysteinemia, depot medroxyprogesterone acetate injection) and hereditary risk factors (deficiency of protein C, protein S and antithrombin-III) in a single patient.
脑静脉窦血栓形成（CVT）因其表现多样且如果未被发现和治疗死亡率极高而闻名。另一方面，如果能够通过高度的临床怀疑、支持性影像学检查以及适当的抗凝治疗来识别CVT，患者的生命可以挽救，且功能可完全恢复。临床医生必须仔细筛查CVT潜在的可逆性和遗传性病因，以便采取适当措施预防此类灾难。在此，我们报告一例累及右侧乙状窦和横窦的CVT病例，该患者急性起病，出现左侧偏瘫，无前驱头痛或癫痫发作。患者通过抗凝治疗成功治愈，功能几乎完全恢复。我们还识别出了多种易感因素。据我们所知，这是首例在单一患者中合并多种后天性（哺乳、叶酸缺乏、高同型半胱氨酸血症、醋酸甲羟孕酮注射液）和遗传性危险因素（蛋白C、蛋白S和抗凝血酶III缺乏）的CVT病例。
