Noninfectious thrombosis of the superior sagittal sinus in a patient with iron deficiency anemia.

Letters to the Editor will be published, if suitable, as space permits. They should not exceed 1,000 words (typed double-spaced) in length and may be subject to editing or abridgment. To the Editor. Noninfectious thrombosis of cerebral veins is commonly found in patients with hereditary coagulation or immunologic disorders and during pregnancy or intake of contraceptive drugs. Severe cases are often lethal. A 46-year-old male patient, who had been previously well, was admitted to our intensive care unit with symptoms of nausea, dizziness, pulsatile tinnitus, bradycardia, and iron deficiency anemia. On the fifth day after admission, the patient experienced a paresis of his left arm and, on the seventh day, a paresis of the right abducens nerve. Angiography of the cerebral veins, computed tomography, and magnetic resonance imaging (MRI) showed an approximately 5-cm-long thrombosis of the superior sagittal sinus, beginning at the confluens sinuum. Our further examinations did not reveal any other known causes of cerebral vein thrombosis. This patient's iron deficiency anemia was caused by chronic blood loss due to a prolapse of the lower rectum. After anticoag-ulant treatment with high-dose intravenous heparin for 3 weeks, MRI showed recanalization of the sagittal sinus. Paresis of the arm and the abducens nerve, pulsatile tinnitus, bradycardia, and nausea all disappeared and were retrospectively interpreted as signs of high intracerebral pressure. Following surgical resection of the rectal prolapse, the patient received further anticoagulant therapy with phenprocoumon and was discharged from the hospital in good health. Iron deficiency anemia coinciding with cerebral vein thrombosis has been reported in four patients: in a 22-month-old boy with iron deficiency anemia and thrombocytosis 1 ; in a young woman with hvpochromic anemia and thrombocytosis following surgery 2 ; and in two women with anemia due to chronic bleeding from myoma uteri. 3 In two cases,'* 2 thrombocytosis associated with anemia was assumed to cause cerebral vein thrombosis. However, in the 2 women with myoma uteri 3 and in our patient, thrombocyte counts were normal. Other pathogenetic considerations might include rheologkal phenomena resulting from a relative anemia in the venous sinus system where negative pressure values prevail, or a hypercoagulable state due to chronic blood loss. However, in neither case were parameters indicating coagulation disorders found. With this report, we have sought to focus attention on iron-deficiency anemia, a frequent disorder, coinciding with thrombosis of the cerebral veins, a rare and sometimes lethal disease. Cerebral venous thrombosis …