CONTRALATERAL ACUTE NONTRAUMATIC SUBDURAL HEMATOMA AS A COMPLICATION OF CEREBRAL VENOUS THROMBOSIS
1 Resident, Neurology Department, Faculty of Medicine Sriwijaya University/Moehammad Hoesin General Hospital Palembang
2 Staff, Neurology Department, Faculty of Medicine Sriwijaya University/Moehammad Hoesin General Hospital Palembang
Introduction. Cerebral venous thrombosis (CVT) is one of the rare form of stroke. Despite the development of neuroimaging technology the diagnosis of cerebral venous thrombosis is still a challenging events. one of the rarest form of cerebral venous thrombosis complication is subdural hematoma. The incidence rate from the previous studies only shows three cases in six years. The management of subdural hematoma in cerebral venous thrombosis is challenging due to the use of anticoagulant. Case Report. Male 58 years old presented to neurology clinic with the complaint of chronic headache. The patients had suffers headache for over 1 year without any improvement with no history of head trauma. Head Non Contrast CT Shows the suspicion of sagital sinus dilation. The Magnetic Resonance Venogram (MRV) was perfomed and the results shown thrombosis of left tranverse sinus accompanied with acute subdural hematoma in the right side of the hemisphere. Digital Substraction Angiography (DSA) confirmed a chronic occlusion of left tranverse sinus with a compensation to the cortical vein that drains to left cavernous sinus through superior ophtalmic vein. Abnormal laboratory founding were D-Dimer 8,27, and INR, 0,88. The patient was planned to take 2 milligrams of warfarin for six months.
The management of SDH as a complication of CVT is still controversial due to the rarity of its case. In this patients it was suspected that the contralateral cortical vein compensation causes the vein hypertension that can caused the rupture of veins that bleeds out as a SDH.