ANTICOAGULATION FOR PREVENTION OF CEREBRAL INFARCTS FOLLOWING SUBARACHNOID HEMORRHAGE

BACKGROUND Late neurologic deterioration following subarachnoid hemorr hage is often due to vasospasm and rebleeding. Although the sudden ons et of a focal neurologic deficit can actually be the result of thrombo embolism, anticoagulation has rarely been used in such cases. METHODS We report a case of a 55-year-old woman who developed recurrent transi ent focal neurologic deficits 13 days after having a subarachnoid hemo rrhage, with multiple cerebral infarcts by CT. Two cerebral angiograms showed no aneurysm. Her symptoms and clinical temporal profile were c onsistent with thromboembolic phenomenon. We elected to treat her with systemic anticoagulation. RESULTS The patient had no recurrent events after systemic anticoagulation, hut had episodic sensory changes and a new infarct on MRI once the anticoagulation was discontinued. CONCLU SIONS Anticoagulant was safely administered after subarachnoid hemorrh age (SAH) in this patient and may have been effective in preventing fu rther cerebral ischemic infarction following her SAH. Our patient's cl inical profile of sudden (rather than gradual) onset of a transient fo cal neurologic deficit and resolution of blood on CT indicates one set ting in which the use of heparin may be considered.