Cerebral venous thrombosis following an immunoglobulin-E mediated anaphylactic reaction

Background: Prothrombotic and pro-inflammatory states are known cerebral venous thrombosis risk factors. To date, two cases of venous thrombotic events after immu-noglobulin-E mediated anaphylaxis have been reported. Herein, we describe the first case of cerebral venous thrombosis in close temporal relation with an immuno-globulin-E mediated anaphylactic event. Case description: A 51-year-old female pre-sented with headache, language, and mental disturbance lasting for two days. Two days before the onset, she had undergone a provocative test with deflazacort to study an allergy history; after the test she developed a severe anaphylactic reaction. There were no other comorbidities, and in addition to contraceptive pill, she did not take other medications. On admission the patient was drowsy, with anomic aphasia, inattention and mem-ory impairment. Magnetic Resonance Imaging depicted a left caudate and lentic-ulo-capsulo-thalamic venous infarct and thrombosis in the deep venous system. The patient was treated with anticoagulation and showed progressive improve-ment. Neoplastic and pro-thrombotic diseases were excluded. Conclusion: The close temporal association between the anaphylactic reaction and cerebral venous throm-bosis suggests that anaphylactic reaction could have been a cerebral venous throm-bosis precipitating factor. Immunoglobulin-E have been suggested to have prothrombotic activity by stimulating the release of platelet activation factor, thromboxane A2 and serotonin. This case adds on to the available information on possible cerebral venous thrombosis associated conditions.

Automated summary

This article reports the first case of cerebral venous thrombosis in close temporal relation with an immunoglobulin-E mediated anaphylactic reaction. The patient presented with headache, language, and mental disturbances. Magnetic Resonance Imaging revealed a venous infarct and thrombosis in the deep venous system. The patient was treated with anticoagulation and showed improvement, suggesting that the anaphylactic reaction could have been a precipitating factor for cerebral venous thrombosis.