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Cerebral venous thrombosis: An experience with anticoagulation with low molecular weight heparin  [cached]
Pillai Lalitha,Ambike Dhananjay,Nirhale Satish,Husainy S
Indian Journal of Critical Care Medicine , 2005,
Abstract: Cerebral venous sinus thrombosis [CVST] is often an infrequent cause of neurological dysfunction resulting in admissions in Intensive care units [ICU]. Because of its myriad presentation it may be under diagnosed. Unfractionated Heparin [UFH] has been advocated in treatment but needs frequent monitoring. We studied the clinical profile of patients of cerebral venous sinus thrombosis, use of low molecular weight heparin [LMWH] with emphasis on safety in 64 patients of CVST.
Cerebral venous thrombosis and heparin-induced thrombocytopenia in an 18-year old male with severe ulcerative colitis  [cached]
Gudrun Scheving Thorsteinsson, Maria Magnussson, Lena M Hallberg, Nils Gunnar Wahlgren, Fredrik Lindgren, Petter Malmborg, Thomas H Casswall
World Journal of Gastroenterology , 2008,
Abstract: The risk of thromboembolism is increased in inflammatory bowel disease and its symptoms may be overlooked. Furthermore, its treatment can be complex and is not without complications. We describe a case of an adolescent boy who developed a cerebral sinus venous thrombosis during a relapse of his ulcerative colitis and who, while on treatment with heparin, developed heparin-induced thrombocytopenia (HIT). The treatment was then switched to fondaparinux, a synthetic and selective inhibitor of activated factor X.
Cerebral venous thrombosis in ulcerative colitis.
Srivastava A,Khanna N,Sardana V,Gaekwad S
Neurology India , 2002,
Abstract: Cerebral venous thrombosis is a rare complication of ulcerative colitis. We report a case of 29 year old male who developed superior sagittal, left lateral and sigmoid sinus thrombosis secondary to ulcerative colitis. He was successfully treated with low molecular weight heparin and steroids.
The use of fondaparinux for the treatment of venous thromboembolism in a patient with heparin-induced thombocytopenia and thrombosis caused by heparin flushes
Alex C Spyropoulos,Sharyl Magnuson,Sei Keng Koh
Therapeutics and Clinical Risk Management , 2008,
Abstract: Alex C Spyropoulos1, Sharyl Magnuson1, Sei Keng Koh21Clinical Thrombosis Center, Lovelace Medical Center, Albuquerque, NM, USA; 2Department of Pharmacy, Singapore General Hospital, SingaporeAbstract: Heparin-induced thrombocytopenia (HIT) is an immunologic drug reaction characterized by paradoxical association with venous and arterial thrombosis. The syndrome is caused by IgG antibodies that are reactive against complexes of platelet factor 4 and heparin. Fondparinux does not bind to platelet factor 4, is structurally too short to induce an antibody response, and could in theory be a useful agent to treat HIT. A 69-year-old white female presented with a lower extremity extensive iliofemoral deep vein thrombosis after a right total knee arthroplasty and was subsequently found to have a pulmonary embolism. The patient was noted to have heparin flushes during her operation. Her platelet drop decreased >50% from baseline during initiation of antithrombotic therapy. She was started on subcutaneous fondaparinux 7.5 mg once daily injection. Her serotonin release assay and enzyme-linked immunosorbent assay for heparin antibodies were positive for HIT. Her platelet count nadir was 60 × 103/mm3 on day 5 and the platelet count rebounded after 8 days of fondaparinux therapy. No recurrent thrombotic or bleeding events were noted throughout her therapy. Anecdotal reports have shown that fondaparinux can be a useful agent to treat HIT with or without thrombosis.Keywords: fondaparinux, heparin-induced thrombocytopenia with thrombosis (HITT)
Bilateral Venous Infarcts Secondary To Thrombosis: Two Cases
Hilal HOROZOGLU,Ipek M?D?,Nazire AFSAR
Journal of Neurological Sciences , 2009,
Abstract: Objective: To present two cases with deep-seated bilateral venous infarcts.Case 1: An 18-year-old woman was admitted to the hospital with a state of akinetic mutism, bilateral papiledema and a left-sided hemiparesis (MRC grade 2). Her medical history disclosed multiple attacks of diarrhea during the previous week. Brain MRI showed bilateral, symmetrical thalamic lesions compatible with deep-seated venous infarcts. Brain MR venography revealed a lack of signal at the level of the left lateral and straight sinuses. Laboratory evaluation showed protein C deficiency and heterozygote factor V Leiden mutation. Following intravenous heparin administration, the acute confusional state and left-sided paresis improved.Case 2: A 40-year-old man was admitted to the hospital with an akinetic mutism preceded by an episode of major depression of a few weeks' duration and deep venous thrombosis of the left leg. Brain MRI revealed bilateral hemorrhagic venous infarcts at the level of globus pallidus. Factor V leiden mutation was found and intravenous heparin treatment was begun without major clinical improvement.Conclusion: Bilateral thalamic or basal ganglia infarcts are rarely seen and cerebral venous thrombosis should be considered in the differential diagnosis of such lesions.
Cerebral Sinus Venous Thrombosis due to Asparaginase Therapy  [PDF]
Youssef Alsaid,Shamshad Gulab,Mohammed Bayoumi,Saleh Baeesa
Case Reports in Hematology , 2013, DOI: 10.1155/2013/841057
Abstract: We report a 9-year-old boy with acute lymphoblastic leukemia (ALL) in high-risk group who suffered from left sided focal seizures and ipsilateral hemiparesis during his induction with Asparaginase chemotherapy. Superior sagittal sinus thrombosis and right frontal hemorrhage were demonstrated on brain magnetic resonance imaging (MRI) scans . Anticoagulation was initiated with unfractionated heparin and switched to low molecular weight heparin after 3?weeks and continued for 6?months. At one-year followup, he had complete response to chemotherapy for ALL, with residual mild left hemiparesis, and his MRI scans revealed recanalized venous sinuses. The case highlights the importance of considering cerebral venous thrombosis as a complication of Asparaginase therapy. 1. Introduction Cerebral venous sinus thrombosis (CVST) in children is rare. However, CVST is being increasingly recognized because of greater clinical awareness among clinicians, availability of sensitive neuroimaging techniques, and the survival of children with previously lethal diseases that confer a predisposition to sinovenous thrombosis [1]. One such predisposing condition is acute lymphoblastic leukemia (ALL) and its intensive induction chemotherapy. The importance of chemotherapy in the pathogenesis of ALL-associated CVST is indicated by the observation that over 90% of cases occur during induction therapy; therefore, research has focused on chemotherapeutic agents administered and their influence on hemostasis [2]. Alterations in hemostasis have been well documented in children receiving Asparaginase as a single agent or in combination with prednisolone [2–5]. Cerebral venous sinuses thrombosis is a unique feature of Asparaginase-related thrombosis and is reported to occur in 1%–3% of patients [2]. Herein, we report a case of CVST in a 9-year-old boy undergoing induction chemotherapy for ALL. The correlation of CVST with hypercoagulable state, clinical-radiological features, and treatment are discussed. 2. Case Report A 9-year-old boy presented to emergency department with headache and focal seizures of 1-day duration. He was newly diagnosed, on February 2012, with ALL and was just started his daily oral prednisolone, daunorubicin, weekly intravenous vincristine, and intrathecal chemotherapy. On day 3 of induction protocol, intramuscular polyethylene glycosylated- (PEG-) Asparaginase, the polyethylene glycol conjugate of E. coli L-Asparaginase (2500?IU/m2) was administered. His symptoms started on day 24 of induction protocol; he started complaining of severe headache and developed
Liposomal Heparin-Spraygel in Comparison with Subcutaneous Low Molecular Weight Heparin in Patients with Superficial Venous Thrombosis. A Randomized, Controlled, Open Multicentre Study  [PDF]
Katzenschlager R,Hirschl M,Minar E,Ugurluoglu A
Journal für Kardiologie , 2003,
Abstract: Liposomales Heparin-Spraygel im Vergleich zu subkutanem niedermolekularem Heparin bei Patienten mit oberfl chlicher Venenthrombose. Eine randomisierte, kontrollierte, offene Multicenter-Studie. Ziel: Die oberfl chliche Venenthrombose (superficial vein thrombosis, SVT), die durch Kompressionsbehandlung sowie lokal angewandte oder systemische nichtsteroidale Antiphlogistika hinreichend behandelt werden kann, wird generell als relativ harmlos eingestuft. Allerdings kann eine SVT auch tiefer gehen, was eine aggressivere chirurgische und/oder systemische Behandlung n tig macht. In der vorliegenden randomisierten, kontrollierten, offenen, multizentrischen Vergleichsstudie wurden Wirkung und Toleranz des neuen galenischen liposomalen Heparin-Spraygels mit subkutan verabreichtem niedermolekularem Heparin verglichen. Methodik: 42 Patienten (31 Frauen, 11 M nner) mit diagnostizierter SVT, mittels Duplex-Sonographie best tigt, wurden eingeschlossen. Alle Patienten erhielten eine Kompressionstherapie, darüber hinaus war es ihnen erlaubt, Paracetamol (1000 mg/Tag) als Schmerzhemmer einzunehmen. Die Behandlungsergebnisse wurden nach 7 oder 14 Tagen überprüft. Die prim ren Endpunkte umfa ten Schmerzreduktion (VAS, VRS), Erythema (Planimetrie) und Schwellung (ordinale Skala). Bei jeder Visite wurde die L nge des Thrombus (mm) mittels Duplex-Sonographie gemessen. Ergebnisse: Keiner der 42 Patienten entwickelte eine tiefe Venenthrombose. Das Ergebnis der Schmerzevaluierung (VAS-Evaluation) zeigte eine vergleichbare Schmerzreduktion in beiden Gruppen. Der Medikamentenkonsum war ebenfalls vergleichbar. Erythema und Thrombengr e zeigten einen kontinuierlichen Anstieg in beiden Gruppen, ohne signifikante Unterschiede. Schlu folgerung: Die topische Anwendung von liposomalem Heparin-Spraygel mit Kompressionstherapie zeigte in der Behandlung oberfl chlicher Venenthrombosen eine vergleichbare Wirkung zum subkutan verabreichten niedermolekularen Heparin.
Cerebral Venous Thrombosis: A Mimic of Brain Metastases in Colorectal Cancer Associated with a Better Prognosis  [PDF]
Nida Iqbal,Atul Sharma
Case Reports in Oncological Medicine , 2013, DOI: 10.1155/2013/109412
Abstract: Malignancy is known to be one of the predisposing factors of cerebral venous thrombosis (CVT) due to its hypercoagulable state. CVT is a rare disorder which can lead to frequent misdiagnoses of brain metastases in such cases. We report here the case of a 35-year-old female with metastatic colon adenocarcinoma presenting with sudden neurological symptoms. Brain MRI and magnetic resonance venography confirmed the presence of CVT. She was treated with low molecular weight heparin followed by warfarin. She recovered and is doing well on warfarin after 5 months of diagnosis of CVT. CVT should be strongly suspected as a cause of neurological dysfunction in any case of disseminated malignancy including colon adenocarcinoma. Rapid diagnosis and initiation of therapy should be considered because of its favourable outcome. 1. Introduction Cerebral venous thrombosis (CVT), that is, any thrombosis that occurs in intracranial veins or sinuses, [1] is a rare disorder affecting approximately 5 persons per million per year with huge regional variations [2]. It accounts for approximately 0.5% of all the strokes and most commonly affects young adults. Many disorders can either cause or just predispose to CVT. They include medical, surgical, and obstetrical causes of deep vein thrombosis, genetic and acquired prothrombotic disorders, cancer and hematological disorders, inflammatory systemic disorders, pregnancy and puerperium, infections, and local causes such as tumors, arteriovenous malformations, trauma, central nervous system infections, and infections of the ear, sinus, mouth, face, and neck [1]. Cerebral venous thrombosis has a wide spectrum of clinical manifestations and modes of onset that may mimic many other neurological disorders and lead to frequent misdiagnosis and delay in treatment. Before the advent of computed tomography (CT) and magnetic resonance imaging (MRI), CVT was usually diagnosed at autopsy. It has got a favourable outcome with case fatality of less than 10% [1]. Cerebral venous thrombosis is a rare paraneoplastic syndrome. Herein, we report a case of metastatic colorectal cancer who developed cerebral venous thrombosis while on chemotherapy. 2. Case Report A 35-year-old female, a diagnosed case of metastatic colorectal adenocarcinoma, (Figure 1) was on palliative chemotherapy with capecitabine and irinotecan (CAPIRI) when she presented with the history of sudden onset of headache, blurring of vision, weakness of left side of body, and multiple episodes of vomitings. She had no history of hypertension, diabetes, pregnancy or use of oral
Cerebral venous thrombosis: Update on clinical manifestations, diagnosis and management  [cached]
Leys Didier,Cordonnier Charlotte
Annals of Indian Academy of Neurology , 2008,
Abstract: Cerebral venous thrombosis (CVT) has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to misdiagnoses. Headache is the most common symptom and may be associated with other symptoms or remain isolated. The other frequent manifestations are focal neurological deficits and diffuse encephalopathies with seizures. The key to the diagnosis is the imaging of the occluded vessel or of the intravascular thrombus, by a combination of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Causes and risk factors include medical, surgical and obstetrical causes of deep vein thrombosis, genetic and acquired prothrombotic disorders, cancer and hematological disorders, inflammatory systemic disorders, pregnancy and puerperium, infections and local causes such as tumors, arteriovenous malformations, trauma, central nervous system infections and local infections. The breakdown of causes differs in different parts of the world. A meta-analysis of the most recent prospectively collected series showed an overall 15% case-fatality or dependency rate. Heparin therapy is the standard therapy at the acute stage, followed by 3-6 months of oral anticoagulation. Patients with isolated intracranial hypertension may require a lumbar puncture to remove cerebrospinal fluid before starting heparin when they develop a papilloedema that may threaten the visual acuity or decompressive hemicraniectomy. Patients who develop seizures should receive antiepileptic drugs. Cerebral venous thrombosis - even pregnancy-related - should not contraindicate future pregnancies. The efficacy and safety of local thrombolysis and decompressive hemicraniectomy should be tested
Controversies of Treatment Modalities for Cerebral Venous Thrombosis  [PDF]
Maria Khan,Ayeesha Kamran Kamal,Mohammad Wasay
Stroke Research and Treatment , 2010, DOI: 10.4061/2010/956302
Abstract: Cerebral vein thrombosis has been well recognized for nearly two centuries. However, therapeutic options for the condition are limited due to lack of large randomized trials. The various modalities reportedly used include antiplatelets, anticoagulation, fibrinolysis, and mechanical thrombectomy. Of these, antiplatelets are the least studied, and there are only anecdotal reports of aspirin use. Anticoagulation is the most widely used and accepted modality with favorable outcomes documented in two randomized controlled trials. Various fibrinolytic agents have also been tried. Local infusions have shown more promise compared to systemic agents. Similarly, mechanical thrombectomy has been used to augment the effects of chemical thrombolysis. However, in the absence of randomized controlled trials; there is no concrete evidence of the safety and efficacy of either of these modalities. Limited study series disclosed that decompression surgery in malignant CVT can be life saving and provides good neurological outcome in some cases. Conclusion. Overall therapeutics for CVT need larger randomized controlled trials. Anticoagulaion with heparin is the only modality with a reasonable evidence to support its use in CVT. Endovascular thrombolysis and mechanical thrombectomy are reserved for selected cases who fail anticoagulation and decompression surgery for malignant CVT with impending herniation. 1. Introduction Cerebral venous thrombosis (CVT) is a well-recognized condition presenting in multiple different forms. It was first described in 1825 [1] in a man who suffered from headaches, seizures, and delirium for six months. His autopsy revealed superior sagittal sinus thrombosis. Since that initial description nearly two centuries ago, several case reports and case series have come out, but the condition continues to be a diagnostic and therapeutic challenge. The estimated incidence is about 2 to 4/million/year [2] and about 75% of these are reportedly women [3]. A recent study in children <18 years found a higher incidence of 6.7/million/year [4]. Also CVT seems to be a bigger problem in the Asian world compared to the west. A report from India by Panagariya et al. suggests that CVT accounts for up to 40% of strokes in women and 50% of all young strokes [5, 6]. Risk factors for CVT have been highlighted in several studies and case series. The largest trial to date was the International study on cerebral vein and dural sinus thrombosis (ISCVT) [7]. This was a prospective, observational study from 21 different countries in which 624 patients with CVT were followed
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