Four-extremity deep venous thrombosis on a brain injury rehabilitation unit: case report

Lower extremity deep venous thrombosis (LE DVT) is a fairly common conditio n among brain injury rehabilitation patients, occurring in up to 20% of all admissions. Upper extremity deep venous thrombosis (UE DVT) is less common . However, its incidence is expected to increase due to the increasing usag e of central venous catheterization (CVC). This paper reviews the course of treatment of a patient with recurrent malignant meningioma who was found t o have four-extremity deep venous thrombosis on a baseline screening duplex Doppler ultrasonography at admission to an inpatient brain injury rehabili tation unit. The need for tumor embolization followed by surgical resection was felt to preclude chemical prophylaxis for DVT despite the significant risk factors of; age > 60, immobility, quadriplegia, surgery with anesthesi a > 30 minutes, and diagnosis of cancer. Aggressive anticoagulation with cl ose clinical monitoring allowed for successful participation in a full reha bilitation with only a brief delay. The appropriate treatment of this patie nt is discussed in light of the latest research findings. Recommendations f or future treatment protocols and research are made.