Farfouti M Taher, Masri Christina, Ghabally Mike, Roumieh George
MRCP (UK), FRCP (London), Department of Neurology, Aleppo University, Faculty of Medicin, Aleppo, Syria.
University of Aleppo, Department of Internal Medicine, Faculty of Medicine, Aleppo, Syria.
Case Rep Neurol Med. 2022 Aug 19;2022:1346269. doi: 10.1155/2022/1346269. eCollection 2022.
Immune thrombocytopenic purpura is an autoimmune hematological disorder characterized by low platelet level due to its destruction through autoimmune antibodies. Cerebral venous thrombosis is a serious condition defined by a thrombosis in the cerebral venous sinuses that occurs mostly in the presence of a hypercoagulable state. Hemorrhage and thrombosis are processes with a paradoxical etiology; thus, the association between these two conditions seems to be extremely rare. . We herein report a case of a 19-year-old female with a chief compliant of generalized tonic-clonic episode, severe headache, and blurred vision. Physical examination was significant for a bilateral Babinski's sign and severe bilateral papilledema. Laboratory workup, computed tomography, and magnetic resonance imaging were normal except for severe thrombocytopenia. Magnetic resonance venography was diagnostic for cerebral venous thrombosis. Her past medical history was significant for immune thrombocytopenic purpura that was treated with prednisolone 40 mg per day which posed a therapeutic challenge. High-dose prednisolone and platelet transfusion were initiated; enoxaparin was administrated and switched to warfarin after stabilization of platelet count. The patient was neurologically intact after 14 days of appropriate treatment and was on follow-up. Many hypotheses were suggested to explain the unexpected thrombotic events in a patient with immune thrombocytopenic purpura which were related to the disease etiology or treatment, taking into account common risk factors (such as age, obesity, smoking, hypertension, diabetes mellitus, dyslipidemia, splenectomy, and oral contraceptive agents).
The association between immune thrombocytopenic purpura (which is a major risk factor for bleeding) and cerebral venous thrombosis ( which is caused by a thromboembolic event )has carried a major challenge to the management plan. We believe that immune thrombocytopenic purpura and its treatment methods should be taken into consideration as risk factors for thromboembolic phenomenon.
免疫性血小板减少性紫癜是一种自身免疫性血液系统疾病，其特征是由于自身免疫抗体导致血小板水平降低。脑静脉血栓形成是一种严重疾病，由脑静脉窦血栓形成所定义，大多发生在高凝状态下。出血和血栓形成是病因相悖的过程；因此，这两种疾病之间的关联似乎极为罕见。我们在此报告一例19岁女性患者，主要症状为全身强直阵挛发作、严重头痛和视力模糊。体格检查显示双侧巴氏征阳性和严重双侧视乳头水肿。实验室检查、计算机断层扫描和磁共振成像均正常，仅严重血小板减少。磁共振静脉造影诊断为脑静脉血栓形成。她既往有免疫性血小板减少性紫癜病史，曾接受每日40毫克泼尼松龙治疗，这带来了治疗挑战。开始使用大剂量泼尼松龙和血小板输注；给予依诺肝素，并在血小板计数稳定后改用华法林。经过14天适当治疗后，患者神经功能完好，并进行随访。考虑到常见风险因素（如年龄、肥胖、吸烟、高血压、糖尿病、血脂异常、脾切除术和口服避孕药），提出了许多假设来解释免疫性血小板减少性紫癜患者意外发生的血栓事件，这些事件与疾病病因或治疗有关。
免疫性血小板减少性紫癜（出血的主要危险因素）与脑静脉血栓形成（由血栓栓塞事件引起）之间的关联给管理计划带来了重大挑战。我们认为，免疫性血小板减少性紫癜及其治疗方法应被视为血栓栓塞现象的危险因素。
