CASE REPORT: RARE INTRACEREBRAL HEMORRHAGE MANIFESTATION WITH CEREBRAL VENOUS SINUS THROMBOSIS DUE TO SUSPECTED MYELOPROLIFERATIVE DISORDER
Keywords:Cerebral venous sinus thrombosis, myeloproliferative disorder, intracerebral hemorrhage
Stroke in the manifestations of blood disorder such as myeloproliferative disease, or so called myeloproliferative neoplasm, is considered very rare, which only accounts for les than 20% cases, therefore leading to under diagnosis of this disease. As the course of disease progress, the first underlying mechanism is the state of hypercoagulation which leads to trombosis, causing further manifestations of parenchymal hemorrhage. Definite mechanism is still under further investigations. A diagnosis of thrombosis have been described in several literature, although its golden standard is through angiography. A 31-year-old male came to the hospital with chief complaint of a sudden unconsciousness since 1 day before admission, with history of chronic progressive headache as well as vomiting, and a background of dehydration state. His physical examination reveals a somnolent state with right facial nerve paresis right impression and right hemiparesis impression. Funduscopic examination reveals papilledema. His NIHSS score was 15 during admission. Non-contrast brain CT scan reveals intracerebral hemorrhage at left parietal region surrounded by hypodense lesion, revealing sICH score of 5. Digital substraction angiography reveals a cortical sinus and venous trombosis in a portion of superior sagittal sinus and transverse sinus along with the right parietal cortical vein. Patient was treated initially with anticoagulant but follow up workup reveals a new hemorrhage at frontal region leading to a substitution of antiplatelet instead. Patient was admitted for 15 days with significant improvement of muscle strength. Due to its rare course, practitioner lacks attention about this condition, and therefore increased awareness of the odds of having this manifestations should be accounted during clinical practice.
Keywords: Cerebral venous sinus thrombosis, myeloproliferative disorder, intracerebral hemorrhage