Usefulness of Edoxaban for Deep Cerebral Venous Sinus Thrombosis with Hemorrhagic Infarction:A Case Report Takeo AMEMIYA 1 , Toshio UESAKA 2 , Katsuharu KAMEDA 1 , Junji UNO 1 , Shintaro NAGAOKA 1 , Yoshiaki IKAI 1 , Hidefuku GI 1 1Department of Neurosurgery, Pegasus Baba Memorial Hospital 2Department of Neurosurgery, Hamanomachi Hospital Keyword: deep cerebral venous sinus thrombosis , edoxaban , hemorrhagic infarction , Ⅹa inhibitor pp.607-613
Published Date 2017/7/10
DOI https://doi.org/10.11477/mf.1436203559
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 We describe a case of deep cerebral venous sinus thrombosis(DCVST)that was successfully treated by oral administration of the Ⅹa inhibitor edoxaban. A 53-year-old man was admitted to our hospital because of a headache and undifferentiated dizziness. Computed tomography(CT)demonstrated a low-density area in the bilateral thalamus and high-density lesions in the internal cerebral veins(ICVs)and vein of Galen. Magnetic resonance imaging with diffusion-weighted images detected areas of hyperintensity in the bilateral thalamus. Additionally, the inferior sagittal sinus, ICV, and vein of Galen were not detected by CT venography or cerebral angiography. We therefore diagnosed DCVST and started anticoagulation therapy with heparin(Ⅳ)and warfarin. A week after admission, lesions that showed hypointensity on T2 images and high density on CT scans were detected in the bilateral thalamus. We thought that hemorrhagic infarction had occurred in association with DCVST, and changed the anticoagulation therapy to oral administration of edoxaban on day 9. The patient's symptoms gradually diminished, and CT venography indicated partial recanalization of the DCV from the ICV to the vein of Galen on day 72. We report our experience, and discuss the safety and usefulness of the Ⅹa inhibitor for treating DCVST with hemorrhagic infarction.

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