Cerebral Sinus Venous Thrombosis in Systemic Lupus Erythematosus
Downloads
Introduction: Cerebral sinus venous thrombosis (CSVT) is a major cause of stroke in young patients. The incidence of CSVT ranging from 1-12 cases per 1 million adults per year. Autoimmune diseases such as Systemic Lupus Erythematosus (SLE) can cause CSVT. The incidence of CSVT involvement in SLE is 1%. It is characterized by thrombosis in the sinuses and veins, which causes various symptoms, such as headache, seizures, motor weakness, and decreased consciousness. Cases: We report a case of a 20-year-old woman with SLE who complained of seizures accompanied by weakness on both sides of the body and a history of headaches. There is an increase in D-dimer, with positive ANA and anti-ds-DNA tests. A non-contrast CT scan of the head showed a lobar venous infarct with hyperdense lesions, a head non-contrast MRI/MRV revealed a dural sinus thrombosis with a deep cortical/subcortical venous infarct, no bleeding was seen. Patients were given Fondaparinux sodium therapy for 5 days, followed by Warfarin sodium for 3-12 months with a target INR of 2.0-3.0, and control SLE by administering immunosuppressants gave better outcomes for patients. Conclusion: The diagnosis of CSVT in this patient was based on clinical suspicion and imaging confirmation, and elevation of D-dimer. Non-contrast CT of the head as an initial examination often shows normal imaging. Still, there is also an image of a hyperdense lesion that usually causes an incorrect diagnosis, resulting in delays in therapy. Anticoagulation in CSVT should still be given even if there is bleeding.
Saposnik G, Barinagarrementeria F, BrownJr RD, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(4):1158–92.
Singh RK, Bhoi SK, Kalita J, Misra UK. Cerebral venous sinus thrombosis presenting feature of systemic lupus erythematosus. J Stroke Cerebrovasc Dis. 2017;26(3):518–22.
Wang L, Chen H, Zhang Y, Liu W, Zheng W, Zhang X, et al. Clinical characteristic of cerebral venous sinus thrombosis in patients with systemic lupus erythematosus: A single-centre experience in China. J Immunol Res. 2015;1–7.
Zuurbier SM, Coutinho JM. Cerebral venous thrombosis. Adv Exp Med Biol. 2016;183–93.
Duman T, Uluduz D, Midi I, Bektas H, Kablan Y, Goksel BK, et al. A Multicenter study of 1144 patients with cerebral venous thrombosis: The VENOST study. J Stroke Cerebrovasc Dis. 2017;26(8):1848–57.
Gallego IS, Fuentes B, Martinez-Sanchez P, Tejedor ED. Do cerebral venous thrombosis risk factors influence the development of an associated venous infarction? Neurologia. 2011;26(1):13–9.
Guenther G, Arauz A. Cerebral venous thrombosis: A diagnostic and treatment update. Neurologia. 2011;26(8):488–98.
Jia M, Xiong N, Huang J, Wang Y, Zhang X, Zhang Z, et al. Japanese encephalitis accompanied by cerebral venous sinus thrombosis: A case report. BMC Neurol. 2012;12(43):1–5.
Kasjmir YI, Handono K, Wijaya LK, Hamijoyo L, Albar Z, Kalim H, et al. Rekomendasi perhimpunan reumatologi Indonesia untuk diagnosis dan pengelolaan lupus eritematosus sistemik. Perhimpunan Reumatologi Indonesia; 2011. 1–46 p.
Nishida H, Wakida K, Sakurai T. Cerebral venous thrombosis as a complication of neuropsychiatric systemic lupus erythematosus. Intern Med. 2015;54(7):837–41.
Jeltsch-David H, Muller S. Neuropsychiatric systemic lupus erythematosus: pathogenesis and biomarkers. Nat Rev Neurol. 2014;10(10):579–96.
Bazzan M, Vaccarino A, Marletto F. Systemic lupus erythematosus and thrombosis. Thromb J. 2015;13(16):1–10.
de Amorim LC, Rodrigues CE. Stroke in systemic lupus erythematosus and antiphospholipid syndrome: risk factors, clinical manifestations, neuroimaging, and treatment. Lupus. 2017;26(5):529–36.
Unterman A, Nolte JE, Boaz M, Abady M, Shoenfield Y, Zandman-Goddard G. Neuropsychiatric syndromes in systemic lupus erythematosus: a meta-analysis. Semin Arthritis Rheum. 2011;41(1):1–11.
Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol. 2007;6(2):162–70.
Copyright (c) 2022 Asep Riswandi, Pinto Desti Ramadhoni, Nova Kurniati, Raden Muhammad Faisal
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.