Ohta H, Kinoshita Y, Hashimoto M, Yamada H, Urasaki E, Yokota A
Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan.
No To Shinkei. 1998 Aug;50(8):739-43.
A 54-year-old female, who had been treated for aplastic anemia by metenolone acetate since 1981, developed a sudden unconsciousness in September 1995. On admission, she was drowny, CT showed a subarachnoid hemorrhage (SAH) in the right Sylvian fissure. Angiography demonstrated a complete occlusion of the superior sagittal sinus. The SAH was assumed to be originated from rupture of the right Sylvian vein, which was irregularly dilated on angiography. The dural sinus thrombosis was thought to be caused by a long term use of metenolone acetate, and it was discontinued. But her platelet count dropped due to the aggravation of aplastic anemia, and she developed repeated hemorrhagic infarction. An active anticoagulant therapy for the dural sinus thrombosis was thought to be inappropriate because she had the aplastic anemia and the hemorrhagic infarction recurred. We have successfully treated this case by mild anticoagulant therapy with nafamostat mesilate (Futhan).
一名54岁女性，自1981年起接受醋酸美睾酮治疗再生障碍性贫血，1995年9月突然昏迷。入院时，她处于嗜睡状态，CT显示右侧外侧裂蛛网膜下腔出血（SAH）。血管造影显示上矢状窦完全闭塞。推测SAH源于右侧外侧静脉破裂，该静脉在血管造影中呈不规则扩张。硬脑膜窦血栓形成被认为是长期使用醋酸美睾酮所致，遂停用该药。但由于再生障碍性贫血加重，她的血小板计数下降，并出现反复出血性梗死。鉴于她患有再生障碍性贫血且出血性梗死复发，积极的硬脑膜窦血栓抗凝治疗被认为不合适。我们使用甲磺酸萘莫司他（Futhan）进行轻度抗凝治疗，成功治愈了该病例。
