Cerebral Venous Thrombosis Associated with Intracranial Hemorrhage and Timing of Anticoagulation after Hemicraniectomy

Michael A. Pizzi, David A. Alejos, Jason L. Siegel, Betty Y.S. Kim, David A. Miller, William D. Freeman

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background Cerebral venous thrombosis (CVT) is a rare cerebrovascular event that can present with headache, seizure, and focal neurological deficits. Approximately 30%-40% of patients with CVT also present with intracranial hemorrhage. Current guidelines recommend anticoagulation after CVT even in the setting of intracranial hemorrhage, but the timing of initiation is unclear. We present a case of CVT where timing of anticoagulation was unclear by current guidelines. Methods We conducted a literature search with search terms of “cerebral venous thrombosis,” “intracranial hemorrhage,” and “anticoagulation.” Abstracted information included anticoagulation status and time of initiation of anticoagulation. We present a 30-year-old woman with sudden onset of right hemiplegia, global aphasia, and new-onset seizures diagnosed with left transverse and sigmoid sinus thrombosis with intraparenchymal hemorrhage. The patient was treated with endovascular thrombectomy and decompressive hemicraniectomy due to hemorrhage expansion, and anticoagulation was restarted 8 days after hemicraniectomy. Results The literature review demonstrated a wide variation of timing for anticoagulation initiation in patients with CVT and intracranial hemorrhage. Most started anticoagulation within 24 hours of admission with similar functional neurological recovery. Current guidelines on the treatment of CVT, even with intracranial hemorrhage, recommend anticoagulation. Most reports in the literature state initiation of anticoagulation within 24 hours. However, the literature does not definitively state when to initiate anticoagulation in a patient with CVT, intracranial hemorrhage, thrombectomy, and decompressive hemicraniectomy. Conclusion This case illustrates the challenge of determining when to resume anticoagulation for CVT.

Original languageEnglish (US)
Pages (from-to)2312-2316
Number of pages5
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number9
StatePublished - Sep 1 2016


  • Cerebral venous thrombosis
  • anticoagulation
  • craniectomy
  • intracranial hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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