warfarin and Intracranial-Aneurysm

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

Background and Purpose- The effects of anticoagulation therapy and elevated international normalized ratio (INR) values on the risk of aneurysmal subarachnoid hemorrhage are unknown. We aimed to investigate the association between anticoagulation therapy, elevated INR values, and rupture of intracranial aneurysms. Methods- We conducted a case-control study of 4696 patients with 6403 intracranial aneurysms, including 1198 prospective patients, diagnosed at the Massachusetts General Hospital and the Brigham and Women's Hospital between 1990 and 2016 who were on no anticoagulant therapy or on warfarin for anticoagulation. Patients were divided into ruptured and nonruptured groups. Univariable and multivariable logistic regression analyses were performed to evaluate the association of anticoagulation therapy, INR values, and presentation with a ruptured intracranial aneurysm, taking into account the interaction between anticoagulant use and INR. Inverse probability weighting using propensity scores was used to minimize differences in baseline demographics characteristics. The marginal effects of anticoagulant use on rupture risk stratified by INR values were calculated. Results- In unweighted and weighted multivariable analyses, elevated INR values were significantly associated with rupture status among patients who were not anticoagulated (unweighted odds ratio, 22.78; 95% CI, 10.85-47.81 and weighted odds ratio, 28.16; 95% CI, 12.44-63.77). In anticoagulated patients, warfarin use interacts significantly with INR when INR ≥1.2 by decreasing the effects of INR on rupture risk. Conclusions- INR elevation is associated with intracranial aneurysm rupture, but the effects may be moderated by warfarin. INR values should, therefore, be taken into consideration when counseling patients with intracranial aneurysms.

Topics: Adult; Aged; Aneurysm, Ruptured; Anticoagulants; Case-Control Studies; Female; Humans; International Normalized Ratio; Intracranial Aneurysm; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Propensity Score; Risk Factors; Rupture, Spontaneous; Subarachnoid Hemorrhage; Warfarin

Dissection of the carotid and vertebral arteries is most accurately diagnosed with conventional angiography. MR techniques are sensitive for detecting the abnormalities associated with dissection but may lack specificity. We hypothesized that MR may be useful for serial monitoring of dissection and may therefore guide therapy.. All patients with angiographically proven carotid and/or vertebral artery dissection from July 1994 to June 1996 were followed for a median duration of 10.5 months. Of these 29 patients (44 vessels), 18 were concurrently evaluated with MR, and a target group of 9 patients (17 vessels) was prospectively followed with MR at 3-month intervals.. In the 18 patients with both imaging studies at baseline, angiography revealed 30 dissected vessels while MR detected 27 (90%). In the target group of 9 patients, initial MR identified 15 of the 17 dissections diagnosed with angiography. Serial MR revealed complete healing in 5 vessels, improvement in 6 vessels, no change in 4 vessels, and worsening in 2 vessels. The radiographic features most likely to resolve were stenosis and mural hematoma, while occlusion and luminal irregularity tended to persist. Late ischemic events occurred in 2 patients, both with persistent MR evidence of dissection, one while subtherapeutic on warfarin therapy and the other occurring 1 week after warfarin was discontinued.. MR is a reliable noninvasive method for following the vascular response to treatment and may guide the course of a clinical trial comparing medical therapies for carotid and vertebral artery dissection.

Topics: Adolescent; Adult; Anticoagulants; Aortic Dissection; Carotid Arteries; Cerebral Angiography; Child; Female; Humans; Intracranial Aneurysm; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Vertebral Artery; Warfarin; Wound Healing

A 50-year-old man with myelopathy secondary to basilar impression developed bilateral vertebral artery dissection after undergoing treatment with 8 pounds of cervical traction. The vertebral artery dissection resulted in vertebrobasilar insufficiency and posterior circulation stroke. In this report, the current management philosophies in the treatment of basilar impression are discussed, and the pertinent neurovascular anatomy is illustrated. This report suggests that vertebral artery injury may result from attempted reduction of severe basilar impression. Regardless of the cause of cranial settling, the risk of vertebral artery injury with cervical traction should be considered in patients with severe basilar impression.

Topics: Aortic Dissection; Humans; Intracranial Aneurysm; Magnetic Resonance Imaging; Male; Middle Aged; Platybasia; Thrombolytic Therapy; Traction; Urokinase-Type Plasminogen Activator; Vertebral Artery; Vertebrobasilar Insufficiency; Warfarin

There is evidence that vitamin K-deficiency during human pregnancy can be caused by the therapeutic use of warfarin or phenytoin. The pregnancy histories of three cases of Binder's syndrome are reported. One was associated with warfarin exposure, one with phenytoin exposure and one with alcohol abuse. It is proposed that Binder's syndrome can be caused by prenatal exposure to agents that cause vitamin K-deficiency. Sprague-Dawley rats were treated from postnatal day 1 to 12 weeks with daily doses of warfarin (100 mg/kg) and concurrent vitamin K1 (10 mg/kg). This regimen creates a net extra-hepatic vitamin K-deficiency. The treated rats developed with a distinct facial appearance characterized by a markedly reduced snout. Histological examination showed that the normally non-calcified septal cartilage was extensively calcified. It is proposed that normal growth of the septal cartilage is necessary for the development of the profile of the nose and midface and that normal growth will only take place while the septal cartilage is uncalcified.

Topics: Adolescent; Alcoholism; Aneurysm, Ruptured; Animals; Cartilage; Child, Preschool; Female; Humans; Infant; Intracranial Aneurysm; Male; Maxilla; Nasal Bone; Nasal Septum; Phenytoin; Pregnancy; Pregnancy Complications, Cardiovascular; Prenatal Exposure Delayed Effects; Rats; Rats, Sprague-Dawley; Thrombophlebitis; Vitamin K; Vitamin K Deficiency; Warfarin

Cervical internal carotid dissection is not rare. Doppler ultrasound screening of young patients presenting with stroke, identified 10 patients with reduced common and internal carotid blood flow without any evidence of atheroma. Eight, on angiography proved to have a dissection of the cervical internal carotid artery. All were managed conservatively. Seven received anticoagulant therapy, stopping any further neurological symptoms.

Topics: Adolescent; Adult; Aortic Dissection; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Cerebral Infarction; Echoencephalography; Female; Follow-Up Studies; Heparin; Humans; Intracranial Aneurysm; Ischemic Attack, Transient; Male; Middle Aged; Tomography, X-Ray Computed; Warfarin

In a prospective study of 100 consecutive patients who underwent operations for intracranial aneurysms, the incidence of deep vein thrombosis (DVT) was 14%. The diagnosis was based on contrast venography, which was carried out in any patient who showed clinical symptoms and signs of DVT. In the presence of DVT the patient was placed on bed rest and intravenous plus peroral anticoagulation was begun. No complications thought to be related to anticoagulation were observed. A programme of postoperative prophylaxis is suggested for a selected group of aneurysm patients with a high risk for thromboembolic disease.

Topics: Adolescent; Adult; Drug Therapy, Combination; Early Ambulation; Heparin; Humans; Intracranial Aneurysm; Middle Aged; Postoperative Complications; Risk; Thrombophlebitis; Warfarin

Topics: Adult; Aged; Brain; Brain Neoplasms; Cerebral Hemorrhage; Female; Glioma; Humans; Infarction; Intracranial Aneurysm; Intracranial Arteriovenous Malformations; Male; Middle Aged; Tomography, X-Ray Computed; Warfarin

Topics: Cerebral Angiography; Cerebral Hemorrhage; Humans; Intracranial Aneurysm; Male; Middle Aged; Rupture; Vitamin K 1; Warfarin