Arai M, Takeda Y, Ozawa T, Otsuki M
Department of Neurology, Takeda General Hospital.
Rinsho Shinkeigaku. 1995 Jun;35(6):667-9.
A 44-year-old man was admitted, complaining of weakness of his left limbs. On admission, he was oriented and cooperative. He showed positive Barré sign only on the left leg. Deep tendon reflexes were unremarkable; pathological reflexes were negative. There was no cerebellar ataxia or sensory deficit. Immediately after admission, monoplegia of the left leg progressed. He was started on heparin infusion therapy. His paralysis had been resolved by the 5th day. MRI of the brain demonstrated an infarction involving the body of the corpus callosum, the right cingulate gyrus, and the right paracentral lobule. Neuropsychologic examination demonstrated a disturbance of interhemispheric transfer of position. On the 10th day he developed Klebsiella ozaenae bacteremia. On the 11th day, platelet count was 9.2 x 10(4)/microliter. Antithrombin III, thrombin antithrombin III complex, D-dimer, and FDP levels were unremarkable, which is quite atypical for DIC associated with bacterial infection. Platelet factor 4 and beta-thromboglobulin levels were remarkably high, suggesting activated platelet aggregation. We made a diagnosis of heparin-induced thrombocytopenia and discontinued heparin infusion. Three days later, platelet count began to increase and creatinine levels returned normal. All patients receiving heparin should be monitored for platelet count.
一名44岁男性入院，主诉左下肢无力。入院时，他意识清楚且配合。仅左腿巴氏征阳性。腱反射无异常；病理反射阴性。无小脑共济失调或感觉障碍。入院后不久，左腿单瘫进展。开始给予肝素输注治疗。第5天时他的瘫痪已缓解。脑部MRI显示梗死累及胼胝体、右侧扣带回和右侧中央旁小叶。神经心理学检查显示半球间位置转移障碍。第10天他发生了臭鼻克雷伯菌菌血症。第11天，血小板计数为9.2×10⁴/微升。抗凝血酶III、凝血酶 - 抗凝血酶III复合物、D - 二聚体和纤维蛋白降解产物水平无异常，这在与细菌感染相关的弥散性血管内凝血中相当不典型。血小板因子4和β - 血小板球蛋白水平显著升高，提示血小板聚集活化。我们诊断为肝素诱导的血小板减少症并停止肝素输注。三天后，血小板计数开始上升，肌酐水平恢复正常。所有接受肝素治疗的患者都应监测血小板计数。
