Marasco Vincenzo, Gianniello Francesca, Paolucci Aldo, Martinelli Ida, Capecchi Marco
Department of Hematology Fondazione IRCCS Istituto Nazionale dei Tumori Milan Italy.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center Milan Italy.
EJHaem. 2023 Nov 13;5(1):222-224. doi: 10.1002/jha2.803. eCollection 2024 Feb.
Lumbar puncture (LP) is rarely complicated by cerebral vein thrombosis (CVT), especially if other risk factors coexist. We describe the case of a 28-year-old woman who developed CVT after corticosteroid treatment and LP performed for suspected multiple sclerosis. The day after LP, she developed intense headache and on Day 8 generalized tonic-clonic seizures. A brain computed tomography scan showed thrombosis of the superior sagittal sinus and cortical veins. Thrombophilia screening showed heterozygous G20210A prothrombin mutation. Anticoagulant therapy with low molecular weight heparin and then warfarin was administered until Day 16 after LP, when a brain magnetic resonance imaging showed a subdural hematoma. Warfarin was interrupted and dabigatran was started. The patient recovered completely, both from the initial thrombotic event and the hemorrhagic complication. This case highlights the importance to keep in mind CVT in the differential diagnosis of post-LP headache not responsive to standard therapy, and suggests that dabigatran can be considered an effective and safe treatment of CVT.
腰椎穿刺（LP）很少并发脑静脉血栓形成（CVT），尤其是在存在其他危险因素的情况下。我们描述了一例28岁女性的病例，该患者在接受皮质类固醇治疗及因疑似多发性硬化症进行腰椎穿刺后发生了CVT。腰椎穿刺后第二天，她出现剧烈头痛，第8天出现全身性强直阵挛发作。脑部计算机断层扫描显示上矢状窦和皮质静脉血栓形成。血栓形成倾向筛查显示存在杂合子G20210A凝血酶原突变。给予低分子量肝素抗凝治疗，随后使用华法林，直至腰椎穿刺后第16天，此时脑部磁共振成像显示硬膜下血肿。华法林停用，开始使用达比加群。患者从最初的血栓形成事件和出血并发症中完全康复。该病例强调了在对标准治疗无反应的腰椎穿刺后头痛的鉴别诊断中牢记CVT的重要性，并表明达比加群可被视为治疗CVT的一种有效且安全的药物。
