Cerebral Venous Thrombosis Associated with Intracranial Hemorrhage and Timing of Anticoagulation after Hemicraniectomy.
BACKGROUND
Cerebral venous thrombosis (CVT) is a rare cerebrovascular event that can present with headache, seizure, and focal neurological deficits. Approximately 30%-40% of patients with CVT also present with intracranial hemorrhage. Current guidelines recommend anticoagulation after CVT even in the setting of intracranial hemorrhage, but the timing of initiation is unclear. We present a case of CVT where timing of anticoagulation was unclear by current guidelines.


METHODS
We conducted a literature search with search terms of "cerebral venous thrombosis," "intracranial hemorrhage," and "anticoagulation." Abstracted information included anticoagulation status and time of initiation of anticoagulation. We present a 30-year-old woman with sudden onset of right hemiplegia, global aphasia, and new-onset seizures diagnosed with left transverse and sigmoid sinus thrombosis with intraparenchymal hemorrhage. The patient was treated with endovascular thrombectomy and decompressive hemicraniectomy due to hemorrhage expansion, and anticoagulation was restarted 8 days after hemicraniectomy.


RESULTS
The literature review demonstrated a wide variation of timing for anticoagulation initiation in patients with CVT and intracranial hemorrhage. Most started anticoagulation within 24 hours of admission with similar functional neurological recovery. Current guidelines on the treatment of CVT, even with intracranial hemorrhage, recommend anticoagulation. Most reports in the literature state initiation of anticoagulation within 24 hours. However, the literature does not definitively state when to initiate anticoagulation in a patient with CVT, intracranial hemorrhage, thrombectomy, and decompressive hemicraniectomy.


CONCLUSIONS
This case illustrates the challenge of determining when to resume anticoagulation for CVT.
Departments of Neurology, Mayo Clinic, Jacksonville, Florida; Department of Critical Care, Mayo Clinic, Jacksonville, Florida.
Michael A
MA
Pizzi
Department of Critical Care, Mayo Clinic, Jacksonville, Florida.
David A
DA
Alejos
Departments of Neurology, Mayo Clinic, Jacksonville, Florida.
Jason L
JL
Siegel
Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida.
Betty Y S
BY
Kim
Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida.
David A
DA
Miller
Departments of Neurology, Mayo Clinic, Jacksonville, Florida; Department of Critical Care, Mayo Clinic, Jacksonville, Florida; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida. Electronic address: Freeman.william1@mayo.edu.
William D
WD
Freeman
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000000981:diagnostic imaging; D020767:Intracranial Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging; D059906:Neuroimaging; D013997:Time Factors; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging
D000925:Anticoagulants
Cerebral venous thrombosis; anticoagulation; craniectomy; intracranial hemorrhage