warfarin and Headache

Here we describe an 8-year old male child with homozygous sickle cell disease who presented with left parietal skull bone infarction and, during his stay in hospital, developed a right femoral deep vein thrombosis (DVT), both uncommon complications of the disease. He initially presented with severe headache and generalised tenderness of the calvarium, which did not respond to simple analgesics. Scalp swelling in and around the left frontal (including left orbit) and parietal regions developed 24 h after presentation. The differential diagnosis included incipient stroke, acute sickle bone crisis and osteomyelitis, with a possible complication of epidural haematoma, or orbital compression syndrome. An initial exchange blood transfusion did not lead to appreciable reduction in opiate requirements. Significant symptomatic relief was attained only after a second exchange transfusion. The DVT developed at the site of catheterisation (right femoral vein), and this was treated with maximal doses of enoxaparin followed by warfarin. The child is now well and off anti-coagulants. In this article we present a review of the literature and discuss possible mechanisms of these complications in our patient.

Topics: Anemia, Sickle Cell; Anticoagulants; Catheterization; Child; Diagnosis, Differential; Edema; Enoxaparin; Exchange Transfusion, Whole Blood; Femoral Vein; Headache; Humans; Infarction; Male; Osteomyelitis; Parietal Bone; Stroke; Thrombophilia; Thrombophlebitis; Warfarin

A 22-year-old-lady presented with multiple occlusions of the branches of the central retinal artery, accompanied by neuro-encephalic disorders and deafness. This triad is known as SICRET Syndrome (Small Infarction of Cochlear, Retinal and Encephalic Tissue). This rare syndrome, as well referred to as Susac syndrome, affects only the women and the three tissues mentioned above: eye, ear, brain. The course was characterised by a series of partially regressive evolutive steps. A remission had been obtained since two years with immuno-supressor and anti-coagulant therapy. The neuro-encephalic and cochlear disorder regressed in contrast to the severe sequel on the right eye.

Topics: Adult; Anticoagulants; Arterioles; Cerebral Infarction; Cochlea; Deafness; Diagnosis, Differential; Drug Therapy, Combination; Female; Headache; Humans; Immunosuppressive Agents; Infarction; Magnetic Resonance Imaging; Organ of Corti; Prednisolone; Retinal Artery Occlusion; Salicylic Acid; Syndrome; Vertigo; Vision Disorders; Warfarin

Exenatide, a treatment for type 2 diabetes, slows gastric emptying as part of its pharmacologic action and may alter the absorption of concomitant oral drugs. This open-label, 2-period, fixed-sequence study evaluated the influence of exenatide coadministration on the pharmacokinetics and pharmacodynamics of warfarin, a narrow therapeutic index drug, in healthy men (N = 16). A single, 25-mg oral dose of warfarin, with a standardized breakfast, was administered alone in period 1 and concomitantly with 10 microg exenatide subcutaneous twice daily in period 2. Exenatide did not produce significant changes in R- or S-warfarin pharmacokinetics. Although there were minor reductions in warfarin anticoagulant effect, the ratios of geometric means for the area under the international normalized ratio (INR)-time curve from dosing until the time of the last measurable INR value or maximum-observed INR response being 0.94 (0.93-0.96) and 0.88 (0.84-0.92), respectively, the magnitude and direction of these changes do not suggest a safety concern from this interaction.

Topics: Administration, Oral; Adult; Anticoagulants; Area Under Curve; Aryl Hydrocarbon Hydroxylases; Asian People; Chromatography, Liquid; Cytochrome P-450 CYP2C9; Dose-Response Relationship, Drug; Drug Interactions; Exenatide; Genotype; Haplotypes; Headache; Humans; Hypoglycemic Agents; Injections, Subcutaneous; International Normalized Ratio; Male; Mass Spectrometry; Middle Aged; Nausea; Peptides; Venoms; Warfarin

The prognosis of patients with severe pulmonary hypertension (PHT) is poor. To determine prognosis and guide therapy, an acute hemodynamic trial of selective pulmonary vasodilators, usually inhaled nitric oxide (iNO), was performed. We hypothesized that oral sildenafil, a phosphodiesterase-5 inhibitor, is a safe and effective alternative to iNO.. We studied 13 consecutive patients (mean+/-SEM, 44+/-2 years of age; 9 women) referred for consideration of heart-lung transplantation or as a guide to medical therapy. All but one were functional class III or IV. Patients had primary PHT (n=9), pulmonary arterial hypertension (n=2), or secondary PHT (n=2). Hemodynamics and serum cyclic guanosine-monophosphate levels (cGMP) were measured at baseline and at peak effects of iNO (80 ppm), sildenafil (75 mg), and their combination. The decrease in pulmonary vascular resistance was similar with iNO (-19+/-5%) and sildenafil (-27+/-3%), whereas sildenafil+iNO was more effective than iNO alone (-32+/-5%, P<0.003). Sildenafil and sildenafil+iNO increased cardiac index (17+/-5% and 17+/-4%, respectively), whereas iNO did not (-0.2+/-2.0%, P<0.003). iNO increased, whereas sildenafil tended to decrease, pulmonary capillary wedge pressure (+15+/-6 versus -9+/-7%, P<0.0007). Systemic arterial pressure was similar among groups and did not decrease with treatment. cGMP levels increased similarly with iNO and sildenafil, and their combination synergistically elevated cGMP (P<0.0001).. A single oral dose of sildenafil is as effective and selective a pulmonary vasodilator as iNO. Sildenafil may be superior to iNO in that it increases cardiac output and does not increase wedge pressure. Future studies are indicated to establish whether sildenafil could be effective over a longer duration.

Topics: Administration, Oral; Adult; Cyclic GMP; Diuretics; Drug Therapy, Combination; Female; Headache; Hemodynamics; Humans; Hypertension, Pulmonary; Male; Middle Aged; Nitric Oxide; Phosphodiesterase Inhibitors; Piperazines; Predictive Value of Tests; Pulmonary Artery; Pulmonary Circulation; Pulmonary Wedge Pressure; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome; Vascular Resistance; Vasodilator Agents; Warfarin

Topics: Adult; Anti-Inflammatory Agents; Aspirin; Biphenyl Compounds; Blood Coagulation; Blood Urea Nitrogen; Chlorides; Clinical Trials as Topic; Constipation; Diarrhea; Digestive System; Drug Tolerance; Exanthema; Flatulence; Flufenamic Acid; Fluorine; Headache; Heartburn; Humans; Kidney Function Tests; Male; Mefenamic Acid; Methods; Muscle Cramp; Occult Blood; ortho-Aminobenzoates; Placebos; Potassium; Prothrombin; Sleep Initiation and Maintenance Disorders; Sodium; Uric Acid; Vertigo; Vision Disorders; Vomiting; Warfarin

Cerebral venous sinus thrombosis (CVST) is uncommon. Risk factors include inherited and acquired factors. Rapid diagnosis and treatment is essential and can help prevent complications, which can include seizures and visual disturbance. A 25-year-old woman with a background history of CVST and intermittent warfarin use presented to the hospital in 2021 with a 3-month history of progressive eye swelling and headache. Her headache was located in the right frontal region and worsened with movement. Her workup was consistent with recurrent CVST and dural arteriovenous fistula. IR-guided embolization of the fistulas and stenting of her sinuses was performed. She was treated with dual antiplatelet therapy and therapeutic tinzaparin. Her symptoms improved markedly over several days, with improvement in headache and visual acuity. This case illustrates the potential for severe complications including visual disturbance in untreated CVST, as well as the importance of a thorough history and examination in aiding the recognition of the condition.

Topics: Adult; Central Nervous System Vascular Malformations; Clinical Reasoning; Cranial Sinuses; Eye Diseases; Female; Headache; Humans; Sinus Thrombosis, Intracranial; Warfarin

Thalassemia is an inherited disease associated with thromboembolic events (TEE) and cerebral artery disease. Here, we report a patient with beta-thalassemia presenting with intracerebral hemorrhage due to cerebral venous sinus thrombosis (CVST), and intracranial aneurysms were found after examination. We believe that it is very rare for this patient to have two kinds of cerebrovascular diseases.. A 25-year-old woman suffered from headache for nine days. She had a history of thalassemia and splenectomy nine years prior.. Intracranial hemorrhage, Cerebral venous sinus thrombosis, Intracranial aneurysm and double heterozygous beta-thalassemia major.. The patient was treated with low-molecular-weight heparin sodium injection (4100IU sc q12 h) and then switched to warfarin after four days of overlap with low-molecular-weight heparin sodium injection. Oral hydroxyurea was prescribed before discharged from the hospital.. The patient's headache was relieved significantly within 48 h, and re-examination of CT showed that the hemorrhage was completely absorbed one week later.. CVST and intracranial aneurysms are associated with the pathological mechanism of thalassemia, and patients with beta-thalassemia should be monitored and educated for long-term prevention, especially those with risk factors.

Topics: Adult; Angiography, Digital Subtraction; beta-Thalassemia; Cerebral Hemorrhage; Cranial Sinuses; Drug Therapy, Combination; Female; Headache; Heparin, Low-Molecular-Weight; Heterozygote; Humans; Intracranial Aneurysm; Magnetic Resonance Imaging; Sinus Thrombosis, Intracranial; Treatment Outcome; Warfarin

Cardiac tamponade and its protean presentations are well documented. Tamponade presenting after recent cardiac surgery in a patient on anticoagulation is not unknown. However, severe headache as a presenting feature of tamponade is not documented. We describe how one can be misled into investigating causes of headache while the real cause, tamponade, lies hidden.

Topics: Anticoagulants; Cardiac Tamponade; Coronary Artery Bypass, Off-Pump; Diagnosis, Differential; Echocardiography; Headache; Humans; Jugular Veins; Male; Middle Aged; Postoperative Complications; Thrombosis; Warfarin

We report the case of a 59 year old woman who presented with a six week history of worsening bifrontal headache. On CT brain the only abnormal finding was a partially empty sella potentially indicative of increased intracranial pressure. MRI found a large cerebral venous sinus thrombosis in the superior sagittal sinus. Blood tests and a bone marrow biopsy revealed a diagnosis of JAK2 positive primary polycythaemia rubra vera. The lack of sensitivity and specificity of CT in the diagnosis of CVST should engender a low threshold for MRI in patients with risk factors and/or non-diagnostic abnormalities on initial CT. Management of this dual pathology involves both the immediate treatment of the thrombus with heparin bridging to warfarin and the long treatment for polycythaemia involving repeat venesections and cytoreductive therapy.

Topics: Diagnosis, Differential; Empty Sella Syndrome; Female; Headache; Heparin; Humans; Middle Aged; Polycythemia Vera; Sella Turcica; Sinus Thrombosis, Intracranial; Warfarin

Central venous catheter-associated bacteraemia caused by Nocardia species is very rare; the diagnosis of nocardiosis in patients with cancer is challenging because its clinical presentation is varied, sometimes mimicking metastases, and the high index of clinical suspicion is required for prompt institution of therapy. Herein, we report a case of nocardial sepsis with native aortic valve endocarditis in a patient with breast cancer in whom multidisciplinary team involvement and prompt initiation of therapy have led to successful outcome.

Topics: Amikacin; Anti-Bacterial Agents; Anticoagulants; Aortic Valve; Breast Neoplasms; Central Venous Catheters; Clopidogrel; Cough; Endocarditis, Bacterial; Fatigue; Female; Headache; Heart Valve Prosthesis Implantation; Humans; Meropenem; Middle Aged; Nocardia; Nocardia Infections; Platelet Aggregation Inhibitors; Radiography, Thoracic; Sepsis; Treatment Outcome; Warfarin

Postpartum women can develop headache, and their assessment requires a thorough and multidisciplinary approach. If the headache is unresponsive to treatment and accompanied by neurological deficit, neuroimaging needs to be undertaken to rule out other life-threatening causes.

Topics: Adult; Analgesia, Epidural; Anticoagulants; Anticonvulsants; Cerebral Veins; Female; Headache; Heparin; Humans; Postpartum Period; Puerperal Disorders; Sinus Thrombosis, Intracranial; Spinal Puncture; Tomography, X-Ray Computed; Warfarin

Topics: Anemia, Hemolytic; Antibodies, Monoclonal, Humanized; Diagnosis, Differential; Fatigue; Female; Headache; Hematologic Agents; Hemoglobinuria, Paroxysmal; Hemolysis; Humans; Middle Aged; Patient Care Management; Thrombosis; Warfarin

Management of anticoagulated patients after head injury is unclear due to lack of robust evidence. This study aimed to determine the adverse outcome rate in these patients and identify risk factors associated with poor outcome.. Multicentre, observational study using routine patient records.. 33 emergency departments in England and Scotland.. 3566 adults (aged ≥16 years) who had suffered blunt head injury and were currently taking warfarin.. Primary outcome measure was rate of adverse outcome defined as death or neurosurgery following initial injury, clinically significant CT scan finding or reattendance with related complication within 10 weeks of initial hospital attendance. Secondary objectives included identifying risk factors for adverse outcome using univariable and multivariable analyses.. Clinical data available for 3534/3566 patients (99.1%), median age 79 years; mean initial international normalised ratio (INR) 2.67 (SD 1.34); 81.2% Glasgow Coma Scale (GCS) 15: 59.8% received a CT scan with significant head injury-related finding in 5.4% (n=208); 0.5% underwent neurosurgery; 1.2% patients suffered a head injury-related death. Overall adverse outcome rate was 5.9% (95% CI 5.2% to 6.7%). Patients with GCS=15 and no associated symptoms had lowest risk of adverse outcome (risk 2.7%; 95% CI 2.1 to 3.6). Patients with GCS=15 multivariable analysis (using imputation) found risk of adverse outcome to increase when reporting at least one associated symptom: vomiting (relative risk (RR) 1.8; 95% CI 1.0 to 3.4), amnesia (RR 3.5; 95% CI 2.1 to 5.7), headache (RR 1.3; 95% CI 0.8 to 2.2), loss of consciousness (RR 1.75; 95% CI 1.0 to 3.0). INR measurement did not predict adverse outcome in patients with GCS=15 (RR 1.1; 95% CI 1.0 to 1.2).. In alert warfarinised patients following head injury, the presence of symptoms is associated with greater risk of adverse outcome. Those with GCS=15 and no symptoms are a substantial group and have a low risk of adverse outcome.. NCT02461498.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amnesia; Anticoagulants; Brain Injuries, Traumatic; Emergency Service, Hospital; Female; Glasgow Coma Scale; Head Injuries, Closed; Headache; Humans; Male; Middle Aged; Risk Factors; Tomography, X-Ray Computed; Unconsciousness; Vomiting; Warfarin; Young Adult

Topics: Adult; Aphasia; Cerebral Infarction; Early Diagnosis; Echocardiography; Follow-Up Studies; Headache; Humans; Hypereosinophilic Syndrome; Imatinib Mesylate; Magnetic Resonance Imaging; Male; Risk Assessment; Secondary Prevention; Treatment Outcome; Warfarin

Topics: Adult; Anticoagulants; Exercise; Female; Headache; Humans; Migraine without Aura; Pulmonary Embolism; Venous Thrombosis; Warfarin

Topics: Anticoagulants; Blood Coagulation Factors; Child; Enoxaparin; Female; Headache; Hemorrhage; Heparin Antagonists; Humans; Protamines; Treatment Outcome; Venous Thrombosis; Vitamin K; Warfarin

Better identification and triage of acute posterior circulation (PC) stroke patients is needed as the PC ischemic stroke (IS) patients may be allowed longer thrombolysis window than anterior circulation (AC) IS patients and PC patients with hemorrhagic stroke (ICH) may require care in a neurosurgical unit possibly remote from stroke unit.. Consecutive stroke patients treated at a tertiary center with thrombolysis (100% for IS) and/or comprehensive stroke unit care.. Altogether, 1641 patients had AC (75%) and 553 PC strokes. The PC-IS patients were younger (65 vs 70), had less often prior hypertension (51 vs 61%), and were twice more often on warfarin. They presented 3.5 times more often with seizure, vomited five times more often, had headache twice as often, and required intubation 2 to 3 times more often despite equal NIHSS (9 vs 8) or GCS (15 both) scores with AC-IS patients. Among PC patients, IS (n = 190) associated with younger age, prior atrial fibrillation (AF) in 25% and dyslipidemia in ~40%. One-third of PC-ICH patients (n = 363) had headache and vomited at the onset. PC-ICH patients had BP median of 177/92 mmHg and blood glucose 7.4 mmol/l on ER arrival. Warfarin use was twice as common in PC-ICH.. Despite being of typical age for multiple cardiovascular conditions the PC-ICH patients less often have a previous history of AF or dyslipidemia than IS patients do. The vomiting PC-ICH patient with hypertensive BP values often has headache and a red flag for hemorrhage is warfarin treatment.

Topics: Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Brain Infarction; Female; Headache; Humans; Male; Middle Aged; Vomiting; Warfarin

Non-puerperal uterine inversion and cranial nerve palsies in patients with sigmoid sinus thrombosis are both extremely rare. We report a case of a patient who presented with both simultaneously. The symptoms of sigmoid sinus thrombosis resolved with subcutaneous enoxaparin, and an abdominal dissection with removal of the uterus vaginally resulted in a successful outcome for the patient.

Topics: Adult; Anticoagulants; Cranial Sinuses; Drug Administration Schedule; Enoxaparin; Facial Paralysis; Female; Headache; Humans; Hysterectomy; Leiomyoma; Sinus Thrombosis, Intracranial; Treatment Outcome; Uterine Inversion; Uterine Neoplasms; Warfarin

Topics: Anticoagulants; Behcet Syndrome; Diagnosis, Differential; Epilepsy, Tonic-Clonic; Headache; Heparin; Humans; Male; Middle Aged; Muscle Weakness; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Warfarin

Topics: Anticoagulants; Female; Headache; Humans; Intracranial Hypertension; Magnetic Resonance Imaging; Middle Aged; Papilledema; Sinus Thrombosis, Intracranial; Warfarin

Topics: Adult; Anticoagulants; Diagnosis, Differential; Headache; Heparin; Humans; Intracranial Thrombosis; Male; Tomography, X-Ray Computed; Warfarin

A healthy 44-year-old slim female presented with a constant, non-specific dull headache of subacute onset. The examination showed papilloedema but no other problem. On further questioning she revealed transient visual obscurations and pulsatile tinnitus. The CT scan of the brain was normal, the lumbar puncture showed increased pressure but normal cerebrospinal fluid, and the MR scan and MR venogram was reported showing a small area of developmental venous anomaly in the left parietal region but no venous thrombosis. Benign intracranial hypertension (BIH) was diagnosed but later in the course further tests were done as the patient was atypical for BIH, which revealed essential thrombocythaemia. A CT venogram was arranged which showed partly recanalised chronic sigmoid sinus thrombosis with dilation of collaterals. The patient was treated with acetazolamide, wafarin and hydroxycarbamide. The headache resolved quickly and the papilloedema reduced significantly over 6 months.

Topics: Acetazolamide; Adult; Anticoagulants; Anticonvulsants; Diagnosis, Differential; Drug Therapy, Combination; Female; Headache; Humans; Hydroxyurea; Intracranial Hypertension; Pseudotumor Cerebri; Thrombocytopenia; Warfarin

A 36-year-old female presented with dural sinus thrombosis manifesting as marked enlargement of the venous sinus, which could not be differentiated from epidural hematoma on computed tomography during the acute phase. Magnetic resonance imaging showed characteristic serial changes of the thrombus in the healing process. We believe this condition developed from use of oral contraceptives. Systemic anticoagulant therapy was effective without hemorrhagic complication.

Topics: Adult; Anticoagulants; Brain; Cerebral Angiography; Cerebral Veins; Cerebrovascular Circulation; Cranial Sinuses; Female; Headache; Heparin; Humans; Magnetic Resonance Imaging; Nausea; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Topics: Adult; Aged; Aspirin; Confusion; Headache; Heparin; Humans; Ischemic Attack, Transient; Muscle Stretching Exercises; Neck; Simvastatin; Treatment Outcome; Vertebral Artery Dissection; Warfarin

Topics: Blood Component Transfusion; Child; Fibrinolytic Agents; Headache; Heparin; Humans; Immunosuppressive Agents; Male; Nephrotic Syndrome; Prednisolone; Recurrence; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

Topics: Amaurosis Fugax; Anticoagulants; Carotid Artery, Internal, Dissection; Coitus; Female; Headache; Heparin; Humans; Magnetic Resonance Angiography; Middle Aged; Warfarin

The etiology of spontaneous dissection of the carotid and vertebral arteries without antecedent trauma remains unclear. The goal of this 10-year review was to examine factors regarding presentation, diagnosis, treatment, and outcome for all patients at our institution who were diagnosed with spontaneous carotid dissections (SCD) or spontaneous vertebral dissections (SVD) with no prior trauma history. A retrospective chart analysis was performed involving all discharges from UCSD Medical Center from 1995 to 2005. Patients were selected for inclusion based on the diagnosis of carotid or vertebral dissection with no associated traumatic or iatrogenic cause for their presentation. Characteristics of these patients' medical risk factors, presenting symptoms, diagnostic method and time, treatment, and outcomes were analyzed. A total of 20 patients (10 male, age 44.8 +/- 12.9 yrs; 10 female, age 39.6 +/- 14.9 yrs) were included for study. These patients represented 12 cases of SCD and nine SVD. On presentation, a majority of patients with both SVD and SCD reported headache as their primary complaint while a significantly higher rate of nausea (25% vs. 67%, p < 0.01) was reported in SVD. SVD was associated with a significantly longer diagnostic time (11 hr vs. 16 hr, p < 0.01). The most commonly performed diagnostic exam in both SCD and SVD was magnetic resonance angiography (MRA). Anticoagulation was the primary treatment in 11 of 12 SCD and all nine SVD. One patient with persistent, symptomatic bilateral carotid dissection after anticoagulation was treated with stent placement resulting in unilateral intracranial hemorrhage (ICH). Length of stay was significantly longer in SVD (5 d vs. 7 d, p < 0.02). A significantly higher incidence of persistent neurologic deficits on discharge was seen in SCD (71% vs. 33%, p < 0.02). Radiographic evidence of cerebral infarction on discharge had a stronger correlation with clinical deficits in SCD. Although there were only two cases, those treated with endovascular therapy in the setting of SCD suffered complications related to the intervention. On discharge, there did not seem to be a correlation between persistent neurologic deficits and radiographic evidence of infarction in SVD reflecting that recovery after these episodes may not be predictable based on the appearance of the infarction.

Topics: Adult; Anticoagulants; California; Carotid Artery, Internal, Dissection; Cerebral Infarction; Cohort Studies; Female; Fibrinolytic Agents; Headache; Heparin; Humans; Length of Stay; Magnetic Resonance Angiography; Male; Medical Records; Middle Aged; Nausea; Radiography; Retrospective Studies; Stents; Time Factors; Treatment Outcome; Vascular Surgical Procedures; Vertebral Artery Dissection; Warfarin

Deep venous thrombosis (DVT) is common, but only 2%-4% of DVTs involve the upper extremities (Roos in Am J Surg 154:568-73, 1987). Upper extremity DVT has a primary or secondary cause, and primary thrombosis is much rarer than secondary thrombosis. Primary upper extremity DVT comprises effort venous thrombosis and idiopathic thrombosis. Effort subclavian venous thrombosis, also called Paget-Schroetter syndrome, is an uncommon entity, which usually develops after strenuous effort of the upper extremities. Effort thrombosis of the upper extremity has been described in athletes involved in a wide variety of sports, including ball games, combatant sport and heavy athletics, games with rackets or clubs, and aquatic sports (Zell et al. in Angiology 52:337-42, 2001). Push-up exercise is a strengthening exercise for building up strength and endurance in the muscles of the upper arm and shoulders. It is also considered to be a core exercise in shoulder rehabilitation programs to activate the serratus anterior muscle in people with shoulder dysfunction (Ludewig et al. in J Sports Med 32:484-93, 2004). We report what to our knowledge is the first case of effort DVT of an upper extremity caused by push-up exercise.

Topics: Adult; Anticoagulants; Chronic Disease; Exercise Therapy; Female; Follow-Up Studies; Headache; Humans; Phlebography; Subclavian Vein; Tomography, X-Ray Computed; Venous Thrombosis; Warfarin

A 19-year-old woman, 8 days postpartum, presented to the Emergency Department (ED) with a chief complaint of headache, decreased vision, and agitation. Past medical history was unremarkable. Physical examination was remarkable only for dry mucous membranes, decreased visual acuity, and trace pedal edema bilaterally. While in the ED, the patient experienced a generalized tonic-clonic seizure. Computed tomography (CT) scan of the head was suspicious for venous infarction. Magnetic resonance imaging (MRI) and MR venography revealed sagittal sinus and left transverse sinus thrombosis. The risk factors, clinical presentation, diagnostic evaluation, and management of cerebral venous thrombosis are reviewed.

Topics: Adult; Anticoagulants; Cerebral Angiography; Female; Headache; Humans; Hypertension; Phenytoin; Puerperal Disorders; Risk Factors; Seizures; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Warfarin

Topics: Adult; Carotid Artery, Internal, Dissection; Cerebral Angiography; Emergency Medical Services; Female; Headache; Humans; Hypoglossal Nerve Diseases; Tongue; Tongue Habits; Warfarin

Topics: Adult; Drug Interactions; Female; Headache; Humans; Indomethacin; Melatonin; Middle Aged; Molecular Structure; Treatment Outcome; Warfarin

Topics: Adrenal Cortex Hormones; Adult; Anemia, Hemolytic, Autoimmune; Biopsy, Needle; Diagnosis, Differential; Follow-Up Studies; Giant Cell Arteritis; Glomerulosclerosis, Focal Segmental; Headache; Humans; Intracranial Hypertension; Male; Migraine Disorders; Sleep Apnea Syndromes; Vision Disorders; Warfarin

To report two cases of head or neck pain and central retinal artery occlusion associated with spontaneous dissection of the ipsilateral internal carotid artery.. Case reports.. We describe two cases of sudden visual loss caused by central retinal artery occlusion. Both cases were preceded by ipsilateral headaches or neck pain and tinnitus. The patient had no other neurological signs or history of trauma. In both cases, cerebral angiography revealed ipsilateral internal carotid artery dissection.. Ipsilateral headache or neck pain with tinnitus preceding central retinal artery occlusion is highly suggestive of internal carotid artery dissection. Early diagnosis and treatment may reduce the risk of hemispheric stroke.

Topics: Adult; Carotid Artery, Internal, Dissection; Cerebral Angiography; Female; Headache; Heparin; Humans; Middle Aged; Neck Pain; Retinal Artery Occlusion; Visual Acuity; Warfarin

Activated protein C resistance is a recently identified thrombophylic state which results from a mutation in the factor V gene and has been shown to be an important risk factor for peripheral venous thrombosis. We report a case of paediatric stroke in whom we have identified APC resistance.. A boy presented acutely at the age of 6 years with a severe right sided headache, vomiting, unsteadiness and drowsiness which worsened over a period of 40 hours. Prior to this episode, he was neurologically and developmentally normal except for occasional headaches. CT showed low attenuation in the left cerebellar hemisphere, and occipital lobe associated with acute hydrocephalus. Excision biopsy of the left cerebellar cortex revealed inflammation and possible infarction. Although he remained in a 'locked-in' state with a flaccid quadriparesis for six months, he improved and was left with a left side hemiplegia, multiple cranial nerve palsies and a visual field defect. He represented at the age of thirteen years with transient ischaemic attacks and was found be heterozygous for the factor V Leiden mutation. Since he has been warfarinised, his symptoms have improved.. Although cerebellar stroke in childhood is rare, it has been underdiagnosed in the past. As recurrence is common, patients should be fully investigated and followed up long term. Screening for new factor such as APC-resistance is recommended.

Topics: Adolescent; Anticoagulants; Cerebellum; Cerebral Infarction; Cranial Fossa, Posterior; Electroencephalography; Factor V; Headache; Humans; Hydrocephalus; Male; Point Mutation; Protein C; Recurrence; Tomography, X-Ray Computed; Warfarin

Topics: Adolescent; Adult; Female; Fibrinolytic Agents; Headache; Heparin; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Middle Aged; Prognosis; Risk Assessment; Sinus Thrombosis, Intracranial; Treatment Outcome; Warfarin

Cerebral dural sinus thrombosis is an unusual syndrome in which a patient presents with a severe headache that may be associated with diverse neurologic and physical findings. The case of a 31-year-old woman with headache, vomiting, generalized tonic-clonic seizure, and subsequent dense hemiplegia is presented. The patient was diagnosed as having a cerebral dural sinus thrombosis, but only after the diagnosis was missed initially. The syndrome may be difficult to detect because it can mimic several other entities. There are several known or suspected predisposing factors. The syndrome, diagnostic modalities, and therapeutic options are reviewed.

Topics: Adult; Cerebral Hemorrhage; Contraceptives, Oral; Diagnosis, Differential; Female; Headache; Hemiplegia; Heparin; Humans; Magnetic Resonance Imaging; Mannitol; Phenytoin; Seizures; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Warfarin

Topics: Angiography; Blood Protein Disorders; Blood Proteins; Cholesterol; Headache; Humans; Immunoelectrophoresis; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Skin Diseases; Syndrome; Warfarin