A man in his 30s with a history of sickle cell disease presented to the emergency department after experiencing 2 tonic-clonic seizures. He reported having several headaches in the week leading up to the seizure. Neurologic examination findings were nonfocal. Laboratory test result values were significant for the following: hemoglobin, 11.2 g/dL; mean corpuscular volume, 95.2 µm3; and platelets, 736 × 103/µL. Electrophoresis revealed a hemoglobin S level of 52%. The patient reported approximately 1 sickle cell crisis per year and had undergone a left hip replacement due to avascular necrosis. Magnetic resonance imaging revealed a large hemorrhagic infarct in the right temporal lobe (Figure 1). There was a suggestion of thrombosis of the vein of Labbe, which was confirmed on magnetic resonance venography (Figure 2). The patient was treated with phlebotomy (removal of 200 mL of blood) and intravenous hydration, with the goal of lowering the hemoglobin level to less than 10 g/dL. Thrombophilia workup performed when the patient was an outpatient revealed elevated factor VIII levels.
Gold M. Isolated Right Vein of Labbe Thrombosis. JAMA Neurol. 2016;73(1):120–121. doi:10.1001/jamaneurol.2015.3194
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