SINUS VENOUS THROMBOSIS - AN UNUSUAL CAUSE FOR NEUROLOGIC SYMPTOMS AFTER BONE-MARROW TRANSPLANTATION UNDER IMMUNOSUPPRESSION

Background. Hematopoietic and organ transplantations are increasing wo rldwide with more patients receiving immunosuppressive therapy. Neurol ogical problems may complicate the posttransplant period. Possible cau ses include the conditioning regimen (e,g,, seizures with busulfan), c entral nervous system infections (viral, bacterial, and fungal), or fa ctors secondary to the immunosuppressive therapy and side effects of d rug treatment (e.g,, cyclosporine and tacrolimus). Sinus venous thromb osis, the occlusion of a cerebral venous vessel or a sinus, is an unus ual cause of neurologic symptoms in patients after transplantation, an d this has not been reported in the literature previously. Methods. Th ree patients presenting with various neurological symptoms after allog eneic bone marrow transplantation underwent computed tomography scans and magnetic resonance imaging as a primary diagnostic procedure. Resu lts. In all patients, sinus venous thrombosis was found as the cause f or seizures; it was the cause of disturbance of consciousness in two p atients and headaches in two patients. All symptoms resolved without a ny neurologic deficiency after anticoagulation therapy with heparin fo llowed by dicumarol, Conclusion. We conclude that sinus venous thrombo sis should be considered as a cause of neurological symptoms in patien ts after transplantation under immunosuppressive therapy. Diagnosis is rapidly confirmed by noninvasive magnetic resonance imaging angiograp hy, Therapeutic heparinization is the treatment of choice.