Case Report: A Rare Cause of Ischemic Stroke in the Intensive Care Unit: Venous Sinus Thrombosis

Abstract

A 36-year-old female patient had headache and generalized tonic-clonic seizure. Due to headache, nausea, facial twitching, difficulty in swallowing, contraction of jaw, anemiadand generalized tonic convulsion the patient hadundergone cranial computed tomography (CT) and magnetic resonance (MR) venography. The results were found to be consistent with venous infarction and encephalitis in the right temporoparietal region. The patient was administered low molecular weight heparins, antiepileptic medication, acyclovir and ceftriaxone. On the second day, the patient’s tendency to sleep increased and hemiparesis developed in the left upper and lower extremities. The superior sagittal sinus is most commonly affected in venous sinus thrombosis (VST). Symptoms may vary depending on the localization of the thrombosis. Headache, increased intracranial pressure findings, epileptic seizures and focal neurological disorders are the most common clinical findings. In addition to clinical findings, CT, contrast-enhanced MR imaging and MR venography are used in the diagnosis of VST. Oral contraceptive (OCS) use in individuals with genetic risk, labor or a penetrating trauma event may induce VST. It has been shown that there may be a relationship between iron deficiency anemia and VST, especially if the hemoglobin value is below 9 g/dL, which increases the risk of VST. Kidney failure, hypothyroidism, smoking and high homocysteine level are among the other factors that are accused. Treatment of VST should be started immediately. Treatment should be directed towards the primary cause leading to anticoagulation and clinical VST. The ability of venous thrombosis to respond to anticoagulant treatment makes it important to start treatment early. We think that it is important to investigate VST with imaging methods, especially in cases where there are predisposing factors such as pregnancy and OCS use.

Keywords

• sinus vein thrombosis
• stroke
• intensive care