Dias da Costa Mariana, Nascimento Alves Pedro, Aguiar de Sousa Diana, Canhão Patrícia
Stroke Unit, Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
Stroke Unit, Neurology, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
J Stroke Cerebrovasc Dis. 2023 Jan;32(1):106873. doi: 10.1016/j.jstrokecerebrovasdis.2022.106873. Epub 2022 Nov 9.
Prothrombotic and pro-inflammatory states are known cerebral venous thrombosis risk factors. To date, two cases of venous thrombotic events after immunoglobulin-E mediated anaphylaxis have been reported. Herein, we describe the first case of cerebral venous thrombosis in close temporal relation with an immunoglobulin-E mediated anaphylactic event.
A 51-year-old female presented with headache, language, and mental disturbance lasting for two days. Two days before the onset, she had undergone a provocative test with deflazacort to study an allergy history; after the test she developed a severe anaphylactic reaction. There were no other comorbidities, and in addition to contraceptive pill, she did not take other medications. On admission the patient was drowsy, with anomic aphasia, inattention and memory impairment. Magnetic Resonance Imaging depicted a left caudate and lenticulo-capsulo-thalamic venous infarct and thrombosis in the deep venous system. The patient was treated with anticoagulation and showed progressive improvement. Neoplastic and pro-thrombotic diseases were excluded.
The close temporal association between the anaphylactic reaction and cerebral venous thrombosis suggests that anaphylactic reaction could have been a cerebral venous thrombosis precipitating factor. Immunoglobulin-E have been suggested to have prothrombotic activity by stimulating the release of platelet activation factor, thromboxane A2 and serotonin. This case adds on to the available information on possible cerebral venous thrombosis associated conditions.
血栓形成前状态和炎症前状态是已知的脑静脉血栓形成危险因素。迄今为止，已有两例免疫球蛋白E介导的过敏反应后发生静脉血栓事件的报道。在此，我们描述了首例与免疫球蛋白E介导的过敏事件在时间上密切相关的脑静脉血栓形成病例。
一名51岁女性出现头痛、语言及精神障碍，持续两天。发病前两天，她接受了地夫可特激发试验以研究过敏史；试验后她发生了严重的过敏反应。无其他合并症，除避孕药外，未服用其他药物。入院时患者嗜睡，有命名性失语、注意力不集中及记忆障碍。磁共振成像显示左侧尾状核及豆状核-壳核-丘脑静脉梗死及深静脉系统血栓形成。患者接受抗凝治疗后病情逐渐好转。排除了肿瘤性疾病和血栓形成前疾病。
过敏反应与脑静脉血栓形成在时间上的密切关联提示过敏反应可能是脑静脉血栓形成的促发因素。有人提出免疫球蛋白E可通过刺激血小板活化因子、血栓素A2和5-羟色胺的释放而具有促血栓形成活性。该病例补充了有关可能与脑静脉血栓形成相关疾病的现有信息。
