Abstract Details

Title Cerebral venous thrombosis from thrombocytosis in a patient with thalassemia and splenectomy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-010

Objective

To report a case of cerebral venous thrombosis from thrombocytosis in a patient with thalassemia.

Background Cerebral venous thrombosis is an uncommon but serious neurological disorder. Common etiologies include inherited and acquired thrombophilia. Anticoagulation is the standard treatment for patients with thrombophilia. However, in patients without evidence of thrombophilia, further evaluation is essential for appropriate therapy.

Design/Methods

Case Report

Results A 47 year old woman with history of splenectomy and DVT presented with confusion, expressive aphasia and right sided shaking. She denied headache, nausea, vomiting, weakness or numbness. Neurological exam was significant for limited speech output, poor attention and recall. Non-contrast CT and MRI brain at outside hospital showed a left frontal lesion with vasogenic edema, hemorrhage, and cytotoxic edema. She was transferred to our neurosurgery service for biopsy of a possible brain mass. Laboratory studies revealed microcytic anemia, leukocytosis and thrombocytosis. Conventional angiogram showed occlusion of anterior third of superior sagittal sinus (AT-SSS). Follow-up MRV just showed filling defect at the AT-SSS. Since the lesion was unilateral, with vasogenic edema, compression of the sinus by a mass lesion could not be ruled out. Her hypercoagulable workup was negative. Cerebral spinal fluid study showed no evidence of infection or malignancy. She improved with steroids and Keppra therapy with some impulsivity and disinhibition. Due to persistent thrombocytosis, she was treated with Aspirin 81 mg daily for the prevention of thromboembolism. Repeat MRI brain at 2 months showed interval decrease in edema and hematoma. Molecular analysis of hemoglobin showed evidence of delta-Beta thalassemia, which is associated with abnormal platelet activation and higher risk of thromboembolism in splenectomized patients due to thrombocytosis.

Conclusions

Thrombocytosis in the patient with thalassemia and splenectomy may cause cerebral sinus thrombosis. Aspirin is the treatment of choice for prevention of thromboembolism.

Authors/Disclosures
Sahar H. Osman, MD (PPMG) PRESENTER	Dr. Osman has nothing to disclose.
Wengui Yu, MD, PhD (UC Irvine, Neurology Dept)	Dr. Yu has nothing to disclose.

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