Subject(s)
Blood Platelets/drug effects , ChAdOx1 nCoV-19/adverse effects , Lateral Sinus Thrombosis/diagnosis , Platelet Aggregation/drug effects , Platelet Function Tests , Thrombocytopenia/diagnosis , Vaccination/adverse effects , Adult , ChAdOx1 nCoV-19/administration & dosage , Humans , Lateral Sinus Thrombosis/blood , Lateral Sinus Thrombosis/chemically induced , Mean Platelet Volume , Predictive Value of Tests , Thrombocytopenia/blood , Thrombocytopenia/chemically inducedSubject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Sinus Thrombosis, Intracranial/chemically induced , Anticoagulants/therapeutic use , Autoantibodies/immunology , Cerebral Angiography , ChAdOx1 nCoV-19 , Heparin/therapeutic use , Humans , India , Lateral Sinus Thrombosis/chemically induced , Lateral Sinus Thrombosis/diagnostic imaging , Lateral Sinus Thrombosis/drug therapy , Magnetic Resonance Angiography , Male , Middle Aged , Phlebography , Platelet Factor 4/immunology , SARS-CoV-2 , Sagittal Sinus Thrombosis/chemically induced , Sagittal Sinus Thrombosis/diagnostic imaging , Sagittal Sinus Thrombosis/drug therapy , Sinus Thrombosis, Intracranial/diagnostic imaging , Sinus Thrombosis, Intracranial/drug therapy , Thrombocytopenia , Warfarin/therapeutic useABSTRACT
Though patients with diabetes mellitus are at a high risk of atherothrombotic events, every such event should not be attributed to the disease itself. We present a case of a patient with diabetes with headache and blurring of vision for 3 days. Brain imaging revealed right transverse sinus thrombosis and acute infarct of the right posterior parieto-occipital region, predominantly in the posterior cortical watershed zone. The patient was on subcutaneous dulaglutide for 3 weeks and was having nausea and vomiting. Various causes of cerebral venous thrombosis were ruled out with appropriate laboratory investigations. Finally, cerebral venous thrombosis was attributed to dulaglutide-induced nausea and vomiting which led to severe dehydration.
Subject(s)
Diabetes Mellitus, Type 2/complications , Glucagon-Like Peptides/analogs & derivatives , Hypoglycemic Agents/adverse effects , Immunoglobulin Fc Fragments/adverse effects , Lateral Sinus Thrombosis/chemically induced , Recombinant Fusion Proteins/adverse effects , Anticoagulants/therapeutic use , Brain/diagnostic imaging , Brain/physiopathology , Diabetes Mellitus, Type 2/drug therapy , Diagnosis, Differential , Electrocardiography , Female , Fluid Therapy , Glucagon-Like Peptides/adverse effects , Heparin/therapeutic use , Humans , Lateral Sinus Thrombosis/diagnostic imaging , Lateral Sinus Thrombosis/therapy , Magnetic Resonance Angiography , Mannitol/therapeutic use , Middle Aged , Platelet Aggregation Inhibitors/therapeutic useABSTRACT
A 16-year-old girl was diagnosed with widely distributed dural sinus thrombosis (DST) and a haemorrhagic infarct in the left parietal lobe. Despite of heparin treatment, pronounced aggravation of symptoms was observed. Through a femoral vein approach a micro-catheter was advanced into the superior sagittal sinus and rt-PA was infused slowly, directly into the thrombus over 24 hours. A follow up angiogram showed recanalisation of sinus. The patient recovered almost completely, with only few remaining cognitive symptoms. This treatment remains experimental, but should be kept in mind for DST-patients unresponsive to heparin treatment.
Subject(s)
Fibrinolytic Agents/administration & dosage , Lateral Sinus Thrombosis/drug therapy , Sagittal Sinus Thrombosis/drug therapy , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/administration & dosage , Venous Thrombosis/drug therapy , Adolescent , Catheterization , Contraceptives, Oral/adverse effects , Female , Follow-Up Studies , Humans , Infusions, Intralesional , Lateral Sinus Thrombosis/chemically induced , Lateral Sinus Thrombosis/diagnostic imaging , Radiography , Sagittal Sinus Thrombosis/chemically induced , Sagittal Sinus Thrombosis/diagnostic imaging , Superior Sagittal Sinus , Treatment Outcome , Venous Thrombosis/chemically induced , Venous Thrombosis/diagnostic imagingABSTRACT
INTRODUCTION: Women on hormonal therapy for menorrhagia are at risk for cerebral venous thrombosis. CASE REPORT: This scenario may become complicated when there is profuse vaginal bleed with the withdrawal of hormonal therapy. There are no reports describing the possible therapeutic approaches in this clinical situation. RESULTS: A 42-year-old female with a history of uterine fibroids and menorrhagia taking an estrogen-progesterone combination pill presented with seizure clusters. Neuro-imaging showed lateral sinus thrombosis and biparietal hemorrhagic infarcts. Withdrawal of the contraceptive pill was associated with profuse vaginal bleed, leading to hemodynamic instability and the need for multiple blood transfusions. As an emergent procedure to stop the vaginal bleeding, the patient was implanted with a levonorgestrel intrauterine system; with this, vaginal bleed stopped within 12 hours with hemodynamic stability. Subsequently, the patient was treated with unfractionated heparin followed by warfarin (target international normalized ratio: 2.5-3). She made a good neurological recovery. CONCLUSION: This case illustrates that LNG-IUS can be an innovative choice for local hormonal therapy in a patient with OCP-related cerebral venous thrombosis and simultaneous vaginal bleeding.
