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Postpartum cerebral venous thrombosis, congenital protein C deficiency, and activated protein C resistance due to heterozygous factor V Leiden mutation
  1. LAURENT DEREX,
  2. FREDERIC PHILIPPEAU,
  3. NORBERT NIGHOGHOSSIAN,
  4. PAUL TROUILLAS
  1. Service d’Urgences Neurovasculaires, Hôpital Neurologique, Lyon, France
  2. Laboratoire Central d’Hématologie et de Cytogénétique, Hôpital Cardio-Vasculaire et Pneumologique, Lyon, France
  1. Dr Laurent Derex, Service d’Urgences Neurovasculaires, Pr Paul Trouillas, Hôpital Neurologique, 59 Boulevard Pinel, 69003 Lyon, France
  1. MICHELINE BERRUYER
  1. Service d’Urgences Neurovasculaires, Hôpital Neurologique, Lyon, France
  2. Laboratoire Central d’Hématologie et de Cytogénétique, Hôpital Cardio-Vasculaire et Pneumologique, Lyon, France
  1. Dr Laurent Derex, Service d’Urgences Neurovasculaires, Pr Paul Trouillas, Hôpital Neurologique, 59 Boulevard Pinel, 69003 Lyon, France

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Activated protein C resistance (APC-R) due to factor V Leiden mutation is the most common thrombophilia associated with cerebral venous thrombosis. It is present in 10% to 20% of patients but usually in association with other constitutional or acquired prothrombotic conditions.1 We present a case of postpartum cerebral venous thrombosis in a patient with protein C deficiency and APC-R due to heterozygous factor V Leiden mutation. In addition to puerperium, the role of intravenous steroids is questioned in this case.

A 33 year old woman was admitted because of severe subacute headaches, nausea, and drowsiness. She was not taking oral contraceptives. Her medical history disclosed recent delivery of a second child 3 weeks before and an asthma attack 5 days before entry, treated with intravenous methylprednisolone (120 mg daily). Family history disclosed that the patient’s mother had had postpartum lower limb deep vein thrombosis. On admission, clinical examination disclosed papilloedema. There was no fever and no ear, nose, or throat infection. Brain CT showed a right temporal hypodensity, a delta sign, and small ventricles. Brain MRI (with MRA) demonstrated recent superior sagittal sinus, and right and left lateral sinus thrombosis. High dose intravenous heparin was immediately initiated. Heparin treatment was switched to warfarin after 10 days. At 3 months, neurological examination was normal. Follow up MRA showed complete recanalisation of the superior sagittal sinus and the right lateral sinus, and partial recanalisation of the left …

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