title: Cerebral venous thrombosis due to essential thrombocythemia and worsened by heparin-induced thrombocytopenia and thrombosis.
abstract: This case describes the medical history of a 61-year-old woman treated for cerebral venous thrombosis (CVT) leading to diagnosis of essential thrombocythemia (ET). During treatment with unfractionated heparin, after initial improvement of clinical state, signs of cerebral hypertension reappeared. Although the platelet count decreased, heparin-induced thrombocytopenia (HIT) was only suspected 2 days later when it dropped below the standard 150 × 10(9) L(-1) threshold. HIT diagnosis was confirmed by the presence of anti-PF4/heparin IgG. This late finding was the cause of the extension of CVT with worsening of cerebral hypertension necessitating decompressive craniectomy. Elevated basal platelet count due to ET can delay diagnosis and treatment of HIT. In this case, physicians should be more attentive to platelet count variations rather than thrombocytopenia threshold.
authors.affiliation: CHU Nancy, Service de Neurologie, Hopital Central, Nancy, France. s.richard@chu-nancy.fr
authors.forename: Sebastien
authors.initials: S
authors.lastname: Richard
authors.forename: Julien
authors.initials: J
authors.lastname: Perrin
authors.forename: Karine
authors.initials: K
authors.lastname: Lavandier
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lacour
authors.forename: Xavier
authors.initials: X
authors.lastname: Ducrocq
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D056424:Decompressive Craniectomy; D003871:Dermatan Sulfate / Q000627:therapeutic use; D005260:Female; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000627:therapeutic use; D006801:Humans; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D010976:Platelet Count; D011859:Radiography; D013920:Thrombocythemia, Essential / Q000150:complications* / Q000188:drug therapy; D013921:Thrombocytopenia / Q000139:chemically induced / Q000150:complications; D013927:Thrombosis / Q000139:chemically induced* / Q000150:complications; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery
chemical_list: D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid