An unusual presentation of cortical venous thrombosis and its association with typical antipsychotics.
A 41-year-old patient with schizophrenia was admitted to hospital following episodes of unexplained collapse attacks and on and off episodes of frontal headaches for 3 months. After three such episodes of loss of consciousness in 2 weeks duration and subsequent spontaneous recovery, his evaluation which included MRI scan of head revealed extensive cortical venous thrombosis. He was on zuclopenthixol (thioxanthene group) for several months for schizophrenia and was under regular psychiatric evaluation. He was treated for simple lower respiratory infection a week prior to admission. Other causes for any clotting disorders including vasculitic and thrombophilic screen were negative. There was no evidence of focal neurology on examination. Systemic examination was otherwise unremarkable. He was treated initially with unfractionated heparin and subsequently changed to warfarin with target international normalised ratio between two and three for at least 6 months and psychiatrist was advised to stop zuclopenthixol.
Department of Neurosciences, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK. sreeman@doctors.org.uk
Sreeman Narayan
SN
Andole
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002550:Cerebral Veins; D003006:Clopenthixol / Q000009:adverse effects*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012559:Schizophrenia / Q000188:drug therapy*; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014150:Antipsychotic Agents; D014859:Warfarin; D006493:Heparin; D003006:Clopenthixol