Cerebral venous thrombosis associated with tentorial subdural hematoma during oxymetholone therapy

Androgen was reported to cause cerebral venous thrombosis (CVT) during repl acement therapy fur aplastic anemia. Oxymetholone, a synthetic androgen ana logue, has been widely used in the treatment of aplastic anemia. A 40-year- old woman with aplastic anemia visited our hospital because of severe heada che, nausea, vomiting, blurred vision and diplopia for a period of 1 month. She had taken oxymetholone for 2 years. Neurological examination revealed bilateral papilledema and bilateral sixth nerve palsies. Brain magnetic res onance imaging (MRI), performed at the time of admission, demonstrated left -sided tentorial SDH, and focal cerebral thrombosis of the left superficial sylvian vein and sigmoid sinus. MR venography revealed multiple irregulari ties in the superior sagittal sinus and left transverse sinus. CVT with ten torial subdural hematoma (SDH) caused by oxymetholone was strongly suggeste d. Oxymetholone was immediately discontinued, and her symptoms and signs di sappeared. Because of the thrombocytopenia, anticoagulation was not started . She was discharged and visited the. outpatient clinic without neurologica l symptoms for 6 months. This report supports the cautions given about the risk of CVT with oxymetholone supplementation in aplastic anemia. To the be st of our knowledge, this is the first report of CVT associated with tentor ial SDH that was probably caused by oxymetholone. (C) 2001 Elsevier Science B.V. All rights reserved.