A 22-year-old Caucasian male patient, diagnosed two months before CUC with a compatible biopsy.
Treatment consisted of 1000 mg c/8h of methotrexate and prednisone in decreasing doses (5 mg/day), with no current inflammatory activity.
Three days before admission, she complained of severe persistent headache, with vomiting and language disorder.
No fever, photophobia, or visual disturbances
There was no evidence of focal signology or abnormal movements.
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On physical examination, the patient presented malaise, normotensive, environmental saturation 98%, with good perfusion.
Regular cardiac rhythm was 88 bpm.
There were no pleuropulmonary alterations.
Painless abdomen.
Neurologically he was vigilant but confused, with fluent aphasia and impaired understanding.
No alteration in oculomotricity.
Spinal and meningeal sectors were unchanged.
General laboratory evaluation was unremarkable.
Computed axial tomography (CAT) of the brain showed an image suggestive of cortical venous thrombosis with left temporomental parenchymal infarction.
Magnetic resonance imaging (MRI) of the skull with angioresonance in venous time reported left temporal hemorrhagic infarction with thrombosis of the superficial vein and ipsilateral sigmoid venous sinus.
Thrombophilia screening tests were normal (proteins C, S, antithrombin III, resistance to activated protein C, homocysteinemia, factor 20210A, FV Leiden inhibitor, glycoprotein beta
All patients were requested after starting anticoagulant therapy.
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Anticoagulation was initiated with enoxaparin (1 mg/kg subcutaneously every 12 h) with good outcome.
The patient was treated with CUC and prednisone.
The patient was discharged on the 10th day, asymptomatic, continuing anticoagulation with subcutaneous enoxaparin and later with oral coumarins.
