一例由脑窦血栓引起的凸面非动脉瘤性蛛网膜下腔出血。

IF 2 Q2 EMERGENCY MEDICINE
Ali Abasi, Asra Moradkhani, Shiva Rahimi, Hannah Magrouni
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引用次数: 0

摘要

背景:凸面蛛网膜下腔出血(cSAH)是蛛网膜下腔出血的一种不常见表现,指的是脑部凸面局部出血。脑静脉窦血栓形成(CVST)的诊断可能比较困难,尤其是当患者最初表现为蛛网膜下腔出血时。作者介绍了一个病例,然后讨论了病理生理学和处理方法:一名 56 岁的女性患者既往有高血压和缺血性心脏病病史,在经历了一次剧烈头痛后两次癫痫发作,随后来到急诊科就诊。剧烈头痛后出现两次癫痫发作。患者病史中近期疾病、头部外伤、偏头痛病史、吸烟、饮酒或静脉注射药物等均为阴性。根据磁共振静脉造影术(MRV),患者被确诊为 CVST。基因研究进一步确定了凝血酶原和 MTHFR 基因的同源突变。患者开始接受抗凝治疗,每天两次,每次 60 毫克依诺肝素,48 小时后改为华法林,持续 3 个月后改为利伐沙班:本研究强调了将 CVST 作为 SAH 病因的重要性,强调了先进影像学在诊断中的作用,并展示了使用传统和直接口服抗凝药的成功治疗方法。本文提供的见解有助于改善对 CVST 相关 SAH 患者的管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A case of convexity non-aneurysmal subarachnoid hemorrhage caused by cerebral sinus thrombosis.

Background: Convexity subarachnoid hemorrhage (cSAH) is an uncommon presentation of subarachnoid bleeding, referring to bleeding more localized to the convexities of the brain. The diagnosis of cerebral venous sinus thrombosis (CVST) can be difficult especially when patients initially present with cSAH. The authors present a case and then discuss the pathophysiology and management.

Case presentation: A 56-year-old woman with a previous history of hypertension and ischemic heart disease presented to the emergency department after experiencing it. Two seizures following a severe headache. The patient's history was negative for recent illnesses, head trauma, history of migraines, smoking, alcohol consumption, or intravenous drug use. The patient was diagnosed with CVST based on magnetic resonance venography (MRV). Genetic studies further identified homozygous mutations in the Prothrombin and MTHFR genes. Anticoagulant therapy was initiated with 60 mg of Enoxaparin twice daily and subsequently transitioned to Warfarin after 48 h continued for 3 months, and then replaced by rivaroxaban.

Conclusions: This study highlights the importance of considering CVST as a cause of SAH, emphasizes the role of advanced imaging in diagnosis, and demonstrates a successful treatment approach using both traditional and direct oral anticoagulants. The insights provided in this article can contribute to improving the management of patients with CVST-related SAH.

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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
63
审稿时长
13 weeks
期刊介绍: The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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