An electroencephalogram showed slow action, consisting of slow waves while in the anterior areas with some intermittent bi- and triphasic figures. The original computed tomography scan devoid of contrast was ordinary and with Glutamate receptor activation injection of contrast showed left sigmoid sinus and left proximal jugular vein thrombosis. Brain magnetic resonance imaging was not carried out. She was handled with low-molecular-weight heparin at curative doses, and lenalidomide was discontinued. Her clinical program slowly improved. Soon after a month, she was ready to eat on her very own and to stick to a conversation with her family, though she continued to get disoriented. DISCUSSION A number of myeloma, characterized through the proliferation of plasma clone cells secreting an immunoglobulin or one among its fragments, may be a ailment whose incidence increases with age.
1 In elderly people , oral chemotherapy with lenalidomide, a thalidomide analogue, in blend with dexamethasone, is endorsed in individuals who have received at the least a single other former therapeutic agent. Its side effects consist of TAK-875 cytopenia, peripheral thromboembolic occasions, neuropathy, and gastrointestinal signs and symptoms. 2 Thromboembolic events certainly are a normal side effect of therapy with lenalidomide, especially when its related with higher doses of dexamethasone or injections of erythropoietin.three The possibility of thromboembolic occasions with lenalidomide and dexamethasone is observed to range from eight.5% to 15%.
4 Several mechanisms have been completely proposed to describe this chance, which include defective fibrin structure and fibrinolysis as a consequence of substantial immunoglobulin levels, the presence of autoantibodies this kind of as lupus anticoagulant, higher levels of acquired activated protein C resistance, large synthesis of inflammatory markers this kind of as interleukin IL-6, large circulating factor VIII, secretion of von Willebrand component, inhibition of angiogenesis, and modulation of adhesion molecules over the endothelials cells surface.five,six Cerebral venous thrombosis in an individual treated with lenalidomide has seldom been described. The classical signs of cerebral venous thrombosis are lethargy, headache, sensory or motor impairment, and seizures. The diagnosis is confirmed making use of a CT scan with the injection of contrast or MRI. The symptomatology may possibly be atypical, as was witnessed in this case. Cerebral venous thrombosis will have to be thought of in a person who becomes unusually apathic when taken care of with lenalidomide and dexamethasone.
Celiac illness may constitute an extra etiological element since it may hardly ever be linked with cerebral veinous thrombosis, maybe in relation to a deficit in protein S.7,eight The possibility of thromboembolism through treatment with lenalidomide, especially when it is associated with higher doses of dexamethasone or erythropoietin treatment, raises the query of whether or not thromboprophylaxis should be used.