Hospital: Hospital Virgen de Valme.
Ciudad:
Nº:
Aut@r o Autores: D. Calvo Gijón, J. Pérez Tejada, B. Fernández Gordillo.,
Presentación:
A 27-year-old male patient, non-toxic habits or cardiovascular risk factors, presents to the Emergency Department with a one-day history of holocranial headache which is described as oppressive. Patient refers nausea without vomiting. Valsalva maneuver and supine position intensify the pain. No sleep disruption. Neurological examination unremarkable. Three months before, a pure seminomatous germ cell tumour stage IIA according to the AICC/AJCC classification was diagnosed after radical inguinal orchiectomy. Adjuvant chemotherapy was started and the patient received one cycle of cisplatin, etoposide and bleomycin (BEP) at the time of his admittance. Unenhanced cranial CT is performed with negative findings, however patient still refers headache despite usual analgesia and MRI with contrast material administration is performed for further assessment. MRI shows filling defects within the superior sagittal sinus and the left transverse and sigmoid sinuses with a predominantly hyperintense on both T1-weighted images and T2-weighted images of the thrombus. Findings suggest dural venous sinus thrombosis with subacute stage of thrombus development, probably related to chemotherapy.
Discusión:
Cerebral vein and dural sinus thrombosis (CVT) can be a challenging condition to diagnose. The annual incidence ranges from 3 to 4 cases per 1,000,000 adults, 7 cases per 1,000,000 children and 12 cases per 100,000 pregnant women, with a female to male ratio of 2:1. In the absence of vascular risk factors, CVT prevails between the fourth and fifth decade [1]. The most frequent risk factors for CVT are [1]: prothrombotic conditions, oral contraceptives, pregnancy and the puerperium, malignancy, infection and mechanical precipitants. Thomboembolic events are rare but known complications of cisplatin-based chemotherapy used in testicular germ cell cancer, and very few cases of CVT have been reported thus far [2]. In our case, we propose that cisplatin-related hypercoagulability was the main risk factor for the onset of CVT. Urgent neuroimaging with brain MRI and MR venography, or with cranial CT with CT venography if MRI is not an option, will be necessary in patients with clinically suspected CVT as the first step in the diagnostic evaluation [1,2].
Conclusión:
Cerebral vein and dural sinus thrombosis (CVT) can be a challenging condition to diagnose. The annual incidence ranges from 3 to 4 cases per 1,000,000 adults, 7 cases per 1,000,000 children and 12 cases per 100,000 pregnant women, with a female to male ratio of 2:1. In the absence of vascular risk factors, CVT prevails between the fourth and fifth decade [1]. The most frequent risk factors for CVT are [1]: prothrombotic conditions, oral contraceptives, pregnancy and the puerperium, malignancy, infection and mechanical precipitants. Thomboembolic events are rare but known complications of cisplatin-based chemotherapy used in testicular germ cell cancer, and very few cases of CVT have been reported thus far [2]. In our case, we propose that cisplatin-related hypercoagulability was the main risk factor for the onset of CVT. Urgent neuroimaging with brain MRI and MR venography, or with cranial CT with CT venography if MRI is not an option, will be necessary in patients with clinically suspected CVT as the first step in the diagnostic evaluation [1,2].
Bibliografía:
– Vert C, Coscojuela P, Rovira A. Ictus isquémico. Trombosis venosas. Enfermedades cerebrovasculares no ateroscleróticas no hipertensivas. Radiología esencial 2019, 2: 1424-1432. – Papet C, Gutzeit A, Pless M. Two cases of cerebral s