Anticoagulation for prevention of cerebral infarcts following subarachnoid hemorrhage.
BACKGROUND
Late neurologic deterioration following subarachnoid hemorrhage is often due to vasospasm and rebleeding. Although the sudden onset of a focal neurologic deficit can actually be the result of thromboembolism, anticoagulation has rarely been used in such cases.


METHODS
We report a case of a 55-year-old woman who developed recurrent transient focal neurologic deficits 13 days after having a subarachnoid hemorrhage, with multiple cerebral infarcts by CT. Two cerebral angiograms showed no aneurysm. Her symptoms and clinical temporal profile were consistent with thromboembolic phenomenon. We elected to treat her with systemic anticoagulation.


RESULTS
The patient had no recurrent events after systemic anticoagulation, but had episodic sensory changes and a new infarct on MRI once the anticoagulation was discontinued.


CONCLUSIONS
Anticoagulant was safely administered after subarachnoid hemorrhage (SAH) in this patient and may have been effective in preventing further cerebral ischemic infarction following her SAH. Our patient's clinical profile of sudden (rather than gradual) onset of a transient focal neurologic deficit and resolution of blood on CT indicates one setting in which the use of heparin may be considered.
Department of Neurology, Medical College of Ohio, Toledo 43614, USA.
D Z
DZ
Wang
N
N
Futrell
C
C
Taylon
C
C
Millikan
D000925:Anticoagulants / Q000627:therapeutic use*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed
D000925:Anticoagulants