Dural Sinus Thrombosis Complicated with Heparin Induced Thrombocytopenia and Thrombosis (HITT)

Abstract

A case of dural sinus thrombosis complicated with heparin induced thrombocytopenia and thrombosis (HITT) is presented. Interventional neuroradiologic procedures have potential risks of this devastating complication that is related with heparin. Clinical features and pathophysiologic mechanisms of HITT are discussed.

Figure 1

Brain CT shows curvilinear high attenuated lesion on proximal left transverse sinus and torcular (arrow) suggesting dural sinus thrombosis.

Figure 2

A) Left common carotid angiography (AP view) shows total occlusion of left internal carotid artery. B) Right internal carotid angiography (AP view) demonstrates that left hemisphere is supplied by the right side through anterior communicating artery. C) Right internal carotid artery angiography (lateral view) shows the patent anterior 1/3 of superior sagittal sinus (SSS) (arrow) with well-developed venous collaterals and occlusion of the distal SSS (arrow heads). D) Left common carotid angiography (AP view) shows that the left internal carotid artery is open with reconstitution of ante-grade flow. Note, the filling defects in the proximal internal carotid artery.

Figure 3

Temporal changes of the platelet counts are plotted. The platelet counts start to decrease on the 11^th day after heparinization. The black arrow indicates the 13^th day when the patient's clinical condition deteriorated. The platelet counts increase as soon as the heparinization is discontinued.