Abasi Ali, Moradkhani Asra, Rahimi Shiva, Magrouni Hannah
Student of the Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Department of Neurology, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Int J Emerg Med. 2024 Oct 10;17(1):155. doi: 10.1186/s12245-024-00712-3.
Convexity subarachnoid hemorrhage (cSAH) is an uncommon presentation of subarachnoid bleeding, referring to bleeding more localized to the convexities of the brain. The diagnosis of cerebral venous sinus thrombosis (CVST) can be difficult especially when patients initially present with cSAH. The authors present a case and then discuss the pathophysiology and management.
A 56-year-old woman with a previous history of hypertension and ischemic heart disease presented to the emergency department after experiencing it. Two seizures following a severe headache. The patient's history was negative for recent illnesses, head trauma, history of migraines, smoking, alcohol consumption, or intravenous drug use. The patient was diagnosed with CVST based on magnetic resonance venography (MRV). Genetic studies further identified homozygous mutations in the Prothrombin and MTHFR genes. Anticoagulant therapy was initiated with 60 mg of Enoxaparin twice daily and subsequently transitioned to Warfarin after 48 h continued for 3 months, and then replaced by rivaroxaban.
This study highlights the importance of considering CVST as a cause of SAH, emphasizes the role of advanced imaging in diagnosis, and demonstrates a successful treatment approach using both traditional and direct oral anticoagulants. The insights provided in this article can contribute to improving the management of patients with CVST-related SAH.
凸面蛛网膜下腔出血（cSAH）是蛛网膜下腔出血的一种不常见表现，指出血更局限于脑凸面。脑静脉窦血栓形成（CVST）的诊断可能具有挑战性，尤其是当患者最初表现为cSAH时。作者报告了一例病例，然后讨论其病理生理学和治疗方法。
一名56岁女性，既往有高血压和缺血性心脏病史，在经历严重头痛后出现两次癫痫发作，随后就诊于急诊科。患者近期无疾病、头部外伤、偏头痛病史、吸烟、饮酒或静脉药物使用史。基于磁共振静脉血管造影（MRV），该患者被诊断为CVST。基因研究进一步确定了凝血酶原和亚甲基四氢叶酸还原酶（MTHFR）基因的纯合突变。开始使用依诺肝素60mg每日两次进行抗凝治疗，48小时后转为华法林，持续3个月，然后换用利伐沙班。
本研究强调了将CVST视为SAH病因的重要性，强调了先进影像学在诊断中的作用，并展示了使用传统抗凝剂和直接口服抗凝剂的成功治疗方法。本文提供的见解有助于改善CVST相关SAH患者的管理。
