title: In uno omnia: anti-thrombotic agents in challenging comorbidities.
abstract: BACKGROUND
  Recurrent bleedings of cavernous malformations are quite frequent and frightful: survival is especially at risk in patients with brainstem cavernous malformations who cannot benefit from neurosurgical treatments. Nevertheless, pragmatic recommendations to prevent recurrent bleedings are still lacking, raising some questions on the daily clinical management of the above patients.
  
  
  METHODS
  This study reports the case of a 59 year-old woman presenting with past recurrent bleedings from a brainstem cavernous malformation and with indication to start an anti-thrombotic treatment as a consequence of a developing coronary heart disease. Surprisingly, any suggestion about the usage of otherwise indicated anti-platelet treatment and anti-coagulation in patients with cavernous malformations was found in the literature.
  
  
  RESULTS
  The authors faced a therapeutical dilemma with this patient, whose survival would be really at risk because of a 'time bomb in her brainstem'.
  
  
  CONCLUSIONS
  This experience confirms the lack of clear pragmatic recommendations in the clinical management of these patients, whose treatment still represents a medical challenge.
authors.affiliation: Hospital San Raffaele, Post-Coma Intensive and Rehabilitation Care Unit, Cassino, Italy. pistoiafrancesca@hotmail.com
authors.forename: Francesca
authors.initials: F
authors.lastname: Pistoia
authors.forename: Claudio
authors.initials: C
authors.lastname: Ferri
authors.forename: Giovambattista
authors.initials: G
authors.lastname: Desideri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosano
authors.forename: Marco
authors.initials: M
authors.lastname: Sarà
mesh_terms: D001933:Brain Stem / Q000187:drug effects / Q000503:physiopathology; D020785:Central Nervous System Vascular Malformations / Q000150:complications*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications*; D020300:Intracranial Hemorrhages / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents