warfarin and Meningeal-Neoplasms

A 53-year-old woman suffered intracranial hemorrhage from a cerebellar tumor several days after aortic valve replacement. Surgical intervention was not performed because the patient refused blood infusion for religious reasons (Jehovah's Witness). Instead, the anticoagulation therapy was interrupted for a week, and the patient was conservatively treated with administration of mannitol and steroid. The anticoagulation therapy was restarted 7 days after the hemorrhage. The intratumoral hemorrhage did not recur, and no systemic embolism occurred. The tumor was treated with gamma knife radiosurgery 6 weeks after the hemorrhage, under the radiological diagnosis of meningioma. Anticoagulation therapy is routinely used for patients following cardiac surgery to decrease the risk of thromboembolic complications, but also increases the risk of hemorrhagic events which often involve the central nervous system. Temporary discontinuation of anticoagulation therapy is an option for intratumoral hemorrhage in patients with replacement heart valves, and patients with known brain tumors should be informed about the risk of intracranial hemorrhage before cardiac surgery.

Topics: Adrenal Cortex Hormones; Anticoagulants; Aortic Valve; Aortic Valve Insufficiency; Cerebellar Neoplasms; Cerebral Hemorrhage; Cranial Fossa, Posterior; Female; Heart Valve Prosthesis Implantation; Heparin; Humans; Magnetic Resonance Imaging; Mannitol; Meningeal Neoplasms; Meningioma; Middle Aged; Postoperative Complications; Radiosurgery; Thromboembolism; Warfarin

Although the association of coagulopathy and neoplastic disease is well documented, there have been few reports of patients with primary central nervous system tumors who exhibited hypercoagulable states. We report the case of a 58-year-old woman with a recurrent falcine meningioma and repeated episodes of venous thrombosis who developed warfarin-associated breast necrosis on the fifth day of coumadin therapy. Laboratory evaluation at that time demonstrated an elevated prothrombin time and normal activated partial thromboplastin time. Of the 24 cases of warfarin-associated massive necrosis of the breast described in the literature, only one other case was associated with a neoplasm, a resected craniopharyngioma.

Topics: Blood Coagulation Disorders; Breast; Humans; Male; Mastectomy; Meningeal Neoplasms; Meningioma; Middle Aged; Necrosis; Neoplasm Recurrence, Local; Warfarin

A case of spontaneous subdural hematoma in the cervicothoracic region associated with a small meningioma in a patient on anticoagulant therapy is presented. The neurological complications of anticoagulant therapy are discussed briefly. Progressive neurological deterioration in a patient on anticoagulant therapy should prompt the performance of an emergency myelogram and a possible laminectomy in spite of the potential risks of these procedures. Intraspinal bleeding occurs more frequently in the form of an epidural hematoma, but the clinical presentation may not allow differentiation from a subdural hematoma. The possible causal relation between the asymptomatic spinal meningioma, the anticoagulant therapy, and the formation of the subdural hematoma is discussed.

Topics: Female; Hematoma, Subdural; Humans; Meningeal Neoplasms; Meningioma; Middle Aged; Spinal Cord Neoplasms; Warfarin