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Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report

RATIONALE: Multifocal cerebral hemorrhage refers to the cerebral hemorrhage in 2 or more lesions at the same time or 48 h in the brain caused by various causes, which has an acute onset, high mortality rate, and poor clinical treatment effect. Subarachnoid hemorrhage (SAH) is caused by the direct fl...

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Autores principales: Sun, Jing, He, Zhidong, Nan, Guangxian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319967/
https://www.ncbi.nlm.nih.gov/pubmed/30558002
http://dx.doi.org/10.1097/MD.0000000000013476
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author Sun, Jing
He, Zhidong
Nan, Guangxian
author_facet Sun, Jing
He, Zhidong
Nan, Guangxian
author_sort Sun, Jing
collection PubMed
description RATIONALE: Multifocal cerebral hemorrhage refers to the cerebral hemorrhage in 2 or more lesions at the same time or 48 h in the brain caused by various causes, which has an acute onset, high mortality rate, and poor clinical treatment effect. Subarachnoid hemorrhage (SAH) is caused by the direct flow of blood into the subarachnoid cavity due to the rupture of the diseased vessels at the base or surface of the brain. Cerebral venous sinus thrombosis (CVST) affects approximately 5 people per million and accounts for approximately 1% of all stroke events. CVST with both SAH and multifocal intracerebral hemorrhage (ICH) as the first presentation is extremely rare. PATIENT CONCERNS: A 57-year-old woman presented with dizziness, nausea, and vomiting. DIAGNOSIS: Neuroimaging confirmed a diagnosis of CVST. INTERVENTIONS: The patient was treated with dehydration, scavenging free radicals, and nerve protection therapy. OUTCOMES: After 4 weeks of systematic treatment, the patient resumed independent daily activities and was discharged with only slight non-fluent aphasia. She did not exhibit recurrent thrombosis at an 18-month follow-up point. MAIN LESSONS: The usual treatment for sinus thrombosis is anticoagulation or local thrombolysis. Systemic anticoagulation is the first-line treatment for CVST, even in patients with cerebral hemorrhage or SAH. The present patient's hemorrhage clearly contraindicated heparin; therefore, no anticoagulants or thrombolytic agents were administered during the 4-week hospitalization. We discuss issues for consideration in similar cases and provide an example of determining an individualized approach to treatment.
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spelling pubmed-63199672019-01-24 Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report Sun, Jing He, Zhidong Nan, Guangxian Medicine (Baltimore) Research Article RATIONALE: Multifocal cerebral hemorrhage refers to the cerebral hemorrhage in 2 or more lesions at the same time or 48 h in the brain caused by various causes, which has an acute onset, high mortality rate, and poor clinical treatment effect. Subarachnoid hemorrhage (SAH) is caused by the direct flow of blood into the subarachnoid cavity due to the rupture of the diseased vessels at the base or surface of the brain. Cerebral venous sinus thrombosis (CVST) affects approximately 5 people per million and accounts for approximately 1% of all stroke events. CVST with both SAH and multifocal intracerebral hemorrhage (ICH) as the first presentation is extremely rare. PATIENT CONCERNS: A 57-year-old woman presented with dizziness, nausea, and vomiting. DIAGNOSIS: Neuroimaging confirmed a diagnosis of CVST. INTERVENTIONS: The patient was treated with dehydration, scavenging free radicals, and nerve protection therapy. OUTCOMES: After 4 weeks of systematic treatment, the patient resumed independent daily activities and was discharged with only slight non-fluent aphasia. She did not exhibit recurrent thrombosis at an 18-month follow-up point. MAIN LESSONS: The usual treatment for sinus thrombosis is anticoagulation or local thrombolysis. Systemic anticoagulation is the first-line treatment for CVST, even in patients with cerebral hemorrhage or SAH. The present patient's hemorrhage clearly contraindicated heparin; therefore, no anticoagulants or thrombolytic agents were administered during the 4-week hospitalization. We discuss issues for consideration in similar cases and provide an example of determining an individualized approach to treatment. Wolters Kluwer Health 2018-12-14 /pmc/articles/PMC6319967/ /pubmed/30558002 http://dx.doi.org/10.1097/MD.0000000000013476 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle Research Article
Sun, Jing
He, Zhidong
Nan, Guangxian
Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report
title Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report
title_full Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report
title_fullStr Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report
title_full_unstemmed Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report
title_short Cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: A case report
title_sort cerebral venous sinus thrombosis presenting with multifocal intracerebral hemorrhage and subarachnoid hemorrhage: a case report
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319967/
https://www.ncbi.nlm.nih.gov/pubmed/30558002
http://dx.doi.org/10.1097/MD.0000000000013476
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