Successful treatment of plasma exchange for severe cerebral venous thrombosis with thyrotoxicosis.
Although cerebral venous thrombosis (CVT) is generally treated with anticoagulants, some patients have a poor prognosis. We report a 34-year-old woman who developed severe CVT with mental symptoms and intracerebral hemorrhage with central herniation. She had a hypercoagulable state accompanied by thyrotoxicosis. Aggressive medical therapies including unfractionated heparin, a mixture of concentrated glycerin and fructose, and intravenous administration of thiamazole, iohexol, and propranolol were ineffective. The patient was treated with plasma exchange (PE) two times, in addition to aggressive medical therapies. The neurologic symptoms and laboratory data including high levels of thyroid hormones began to improve soon after the first PE. Activated partial thromboplastin time was prolonged after PE although the heparin dose was not changed. After 6 months, her modified Rankin Scale score was 2. PE should be considered for severe CVT as a result of a hypercoagulable state accompanied by thyrotoxicosis, because it not only reduces thyroid hormones, but also might remove multiple prothrombotic factors.
Department of Neurology, Rakuwakai Otowa Hospital, Yamashina-ku, Kyoto, Japan. ukiyohide@yahoo.co.jp
Kiyohide
K
Usami
Tomoharu
T
Kinoshita
Kazuki
K
Tokumoto
Tadashi
T
Ino
Kyoko
K
Ozawa
Toru
T
Kimura
Shigenobu
S
Nakamura
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000150:complications; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D020767:Intracranial Thrombosis / Q000150:complications / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D010314:Partial Thromboplastin Time; D010951:Plasma Exchange; D013963:Thyroid Hormones / Q000097:blood; D013971:Thyrotoxicosis / Q000150:complications / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000150:complications / Q000628:therapy*
D000925:Anticoagulants; D013963:Thyroid Hormones; D006493:Heparin