Anticoagulation for cerebral venous thrombosis with subarachnoid hemorrhage: a case report.
OBJECTIVE
To report the success of anticoagulation (AC) treatment in a case of cerebral venous thrombosis (CVT) with subarachnoid hemorrhage (SAH) in view of the limited evidence seen in the literature supporting such a treatment option.


METHODS
A 38-year-old lady with CVT and SAH presented 12 h after the onset of symptoms. AC with low-molecular-weight heparin was started 4 days later, when the repeated brain CT showed regression of the SAH. Heparin was changed to warfarin, and she was asymptomatic over a 12-month follow-up period.


CONCLUSIONS
In a limited number of small studies, AC has been found to be beneficial for cases of CVT with hemorrhagic complications. The proper time to start AC in such cases was not clearly defined, and a delay of 4-33 days was observed after the onset of symptoms. In cases of spontaneous intracranial hemorrhage (ICH) in general, active bleeding is usually confined to the first 6 h, and chances of hematoma enlargement are higher in the first 24 h. On the other hand, it has been advised to rule out a coincidental vascular malformation and to radiologically confirm regression (or at least non-progression) of the ICH before starting AC.


CONCLUSIONS
AC for cases of CVT may remain beneficial in the presence of SAH. The time to start AC for CVT with hemorrhagic complications is unclear; however, AC was successful when given 4 days after the onset of symptoms in our case. It may be wise to repeat CT after at least 24 h from the onset of symptoms (to confirm regression or at least non-progression of the ICH) before starting AC. It may also be prudent to perform magnetic resonance angiography, or digital subtraction angiography to rule out a coincidental intracranial aneurysm before AC.
Hegazi
Mohamed Osama
MO
Department of Medicine, Al-Adan Hospital, Kuwait. drosama02@gmail.com
Ahmed
Sherif
S
Sakr
Mohamed Gaber
MG
Hassanien
Omar Ahmed
OA
D000328:Adult; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020227:Lateral Sinus Thrombosis / Q000150:complications* / Q000188:drug therapy*; D018810:Magnetic Resonance Angiography; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy*
D017984:Enoxaparin; D005343:Fibrinolytic Agents