In the thick of it: cerebral venous sinus thrombosis precipitated by iron-deficiency anaemia and sickle cell trait

• Published in: BMJ case reports Vol. 2016; p. bcr2016215399
• Main Authors: Boon, Ian S, Starkey, Kerry Jo, Samsonova, Oksana, Johnston, Andrew McDonald
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 17-05-2016; BMJ Publishing Group
• Subjects: Adolescent; Anemia, Iron-Deficiency - complications; Anemia, Iron-Deficiency - drug therapy; Anticoagulants; Blood clots; Headache - etiology; Headaches; Heparin, Low-Molecular-Weight - administration & dosage; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Images In; Iron - administration & dosage; Iron - therapeutic use; Male; Mortality; Other; Sickle cell disease; Sickle Cell Trait - complications; Sickle Cell Trait - drug therapy; Sinus Thrombosis, Intracranial - diagnostic imaging; Sinus Thrombosis, Intracranial - drug therapy; Sinuses; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; United Kingdom
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2016-215399

CVST is a form of venous thrombosis within the intracranial venous sinuses. 1 The incidence is 3-4 cases per million individuals with an 8% mortality rate. 2 CVST is predisposed to by prothrombotic disorders, anaemia and is associated with a number of clinical conditions. 1 2 Sickle cell disease contributes to a hypercoagulable state by distortion of the phospholipid membrane of red blood cells and inappropriate activation of tissue factors on endothelial cells. 3 Learning points Cerebral venous sinus thrombosis (CVST) is a rare entity which usually presents subacutely over several days or weeks. 1 2 Patients present with wide-ranging symptoms, commonly headache, neurologic deficit, altered consciousness and seizures reflecting the underlying brain damage and raised intracranial pressure due to venous thrombosis. 1 2 CVST may be provoked by prothrombotic factors associated with anaemia and a myriad of other clinical conditions, including sickle cell disease, protein C and protein S deficiency, anticardiolipin antibodies, systemic lupus erythematous, dehydration, infection, sepsis and malignancy. 1 2 These medical conditions should be investigated and excluded. Low-molecular-weight heparin should be followed by treatment with warfarin. 1 2 Direct oral anticoagulants are not yet licensed for treatment of CVST.