title: Simultaneous presentations of deep vein thrombosis and cerebral sinus thrombosis in a case of primary antiphospholipid syndrome.
abstract: Antiphospholipid syndrome is characterized with arterial and venous thrombosis. In this article, a 38-year-old man presented with headache and swelling of his left limb, which had lasted for 2 months. Duplex ultrasonography showed thrombosis of the left femoral vein. Cerebral magnetic resonance imaging also showed cerebral sinus thrombosis. Serological examination showed that antiphospholipid syndrome was the underlying disease condition in this patient. Despite adequate anticoagulant therapy, deep vein thrombosis and cerebral sinus thrombosis exacerbated, resulting in inferior vena cava occlusion, papilloedema, and abducent nerve paralysis. Optic canal decompression and cistern-peritoneal shunt operation were performed, following which his neurological symptoms were relieved. The occurrence of cerebral sinus thrombosis as initial presentation of antiphospholipid syndrome is extremely rare and remains a diagnostic challenge. Although the clinical presentation is highly variable, the diagnosis should be considered in patients with antiphospholipid syndrome presenting with recent unusual headaches. Improved diagnosis and treatment strategy may ultimately improve the clinical outcome of these patients.
authors.affiliation: Department of Medicine, National Cardiovascular Center, Osaka, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Sakamoto
authors.forename: Koichi
authors.initials: K
authors.lastname: Akutsu
authors.forename: Kayoko
authors.initials: K
authors.lastname: Kawase
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Takada
authors.forename: Hidenori
authors.initials: H
authors.lastname: Seyama
authors.forename: Jun
authors.initials: J
authors.lastname: Takahashi
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonogi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takeshita
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D002533:Cerebral Angiography; D019299:Decompression, Surgical; D005268:Femoral Vein / Q000473:pathology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D012851:Sinus Thrombosis, Intracranial / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D017287:Ventriculoperitoneal Shunt
chemical_list: D000925:Anticoagulants