Scalp Veins Research Articles

Adaptive treatment strategy for a vestibular schwannoma in a patient with vascular Eagle syndrome: illustrative case.

Eagle syndrome, an uncommon condition, causes symptoms due to neural and/or vascular compression from an elongated styloid process or calcified stylohyoid ligament and can also complicate other planned surgical procedures. A 42-year-old female with loss of balance, dizziness, and ataxic gait underwent cranial magnetic resonance imaging (MRI), revealing a right-sided Koos grade IV vestibular schwannoma. Initially, a retrosigmoid craniotomy for tumor resection was planned. However, preoperative MRI and computed tomography (CT) showed a dilated right-sided mastoid emissary vein, tortuous scalp and paraspinal veins, and bilateral elongated styloid processes. CT angiography and digital subtraction angiography indicated Eagle syndrome-related compression of both internal jugular veins and concurrent occlusion of the left internal jugular vein at the jugular foramen. Consequently, given the risk of damaging venous structures, Gamma Knife radiosurgery was chosen over resection. This case highlights the importance of adapting treatment plans based on patient-specific anatomical and pathological factors. In situations in which traditional surgery poses risks to sensitive structures such as the venous system, alternative approaches like radiosurgery offer safer yet effective options. Comprehensive risk-benefit evaluations are crucial for such decisions.

Sinus pericranii associated with syntelencephaly: a case report

BackgroundSinus pericranii is a rare cranial venous malformation resulting in a subcutaneous mass due to abnormal communication between intracranial and subperiosteal/interperiosteal veins. To date, to the best of our knowledge, there are no reports of sinus pericranii associated with syntelencephaly, a subtype of lobar holoprosencephaly. We herein report a case of sinus pericranii associated with syntelencephaly. This report can provide us better understanding of the etiology of sinus pericranii, the potential risks, and the treatment options for these patients.Case presentationA 2-year-4-month old female patient who received the diagnosis of syntelencephaly as a neonate presented with a subcutaneous mass in the parietal region. The mass was soft, nonpulsatile, 3 × 2 cm in size, and showed enlargement in the lying position. Color cranial Doppler ultrasound, head magnetic resonance imaging (MRI), and cerebral angiography revealed a dilated vessel passing through the parietal bone and forming a communication between the superior sagittal sinus and scalp veins. Based on these findings, sinus pericranii was diagnosed. The head MRI also showed coronal craniosynostosis, a tight posterior fossa. At age 2 years and 7 months, the patient underwent a transection of the sinus pericranii and the mass resolved without any complications or recurrences for more than 2.5 years to date.ConclusionSinus pericranii is a rare cranial and venous malformation sometimes accompanied by brain malformations or craniosynostosis that may become more apparent as the brain and skull develop. Since this condition can be complicated by intracranial hemorrhage and sinus thrombosis, early detection is necessary to determine the treatment options. Physicians should be alert to the possibility of this condition if they observe a soft cranial mass that appears to decrease in size in the sitting position and bulge in the lying position.

Ocular manifestations of Hutchinson-Gilford-Progeria syndrome: A rare presentation

The Hutchinson-Gilford Progeria (HGP) syndrome is an exceptionally rare genetic condition characterized by premature and accelerated aging in children. It is demonstrated by developmental delay along with progressive degenerative changes of the integumentary, musculoskeletal, cardiac, and vascular systems. In this case report, we describe the ocular manifestations of Hutchinson-Gilford Progeria (HGP) syndrome of a 20-year-old Bangladeshi boy. The patient had the classic triad of prominent eyes, loss of eyebrows or madarosis and lagophthalmos, which are the most common ocular manifestations.He also developed dry eye, keratinized ocular surface, Meibomian gland dysfunction, vascularized cornea, symblepharon, corneal opacification, and cataract. He had several systemic manifeastations that included senile facies, prominent scalp veins, generalized alopecia with plucked bird appearance, and sclerodermatous changes.

Influencing factors of neonatal peripherally inserted central venous catheter (PICC)-related phlebitis: a systematic review, meta-analysis and network meta-analysis

A peripherally inserted central venous catheter (PICC) plays an important role in the security of newborns, especially very low birth weight infants and extremely very low birth weight infants. However, PICC-related phlebitis can seriously affect the normal use of catheters and even cause unplanned removals of catheters. In this review, we systematically reviewed and explored the influencing factors of neonatal PICC-related phlebitis. The PubMed, Embase, CENTRAL, CINAHL, CBM, Wanfang and CNKI databases were searched to collect relevant studies on influencing factors of neonatal PICC-related phlebitis. Review Manager software version 5.3 (RevMan; the Cochrane Collaboration 2012, The Nordic Cochrane Center, Copenhagen, Denmark) and GeMTC software version 0.14.3 (Gert van Valkenhoef, Groningen, The Netherlands ) were used for the meta-analysis and network meta-analysis. A total of 32 studies were included, including 14 randomized controlled trials (RCTs), 2 case-control studies, and 16 cohort studies, involving a total of 8278 neonates. The meta-analysis results showed that the influencing factors of neonatal PICC-related phlebitis were catheter malposition (OR (Odds Ratio) = 5.53, 95% CI (Confidence Interval) (1.22, 25.15)), catheter occlusion (OR = 7.18, 95% CI (3.54, 14.56)), gestational age (OR = 2.51, 95% CI (1.35, 4.66)), using a dexamethasone solution to infiltrate the catheter (OR = 0.26, 95% CI (0.17, 0.41)), and innovative nursing interventions (OR = 0.17, 95% CI (0.07, 0.42)). The network meta-analysis results showed that, compared with lower limb veins, the use of scalp veins (OR = 3.57, 95% CI (1.39, 10.18)) and upper limb veins (OR = 1.89, 95% CI (1.08, 3.37)) had a statistically significant difference in the incidence of phlebitis, while there was no statistically significant difference in the incidence of phlebitis between scalp veins and upper limb veins (OR = 0.53, 95% CI (0.20, 1.26)). PICC puncture of the lower limb veins was most likely to lead to phlebitis, followed by upper limb vein puncture, followed by scalp vein puncture. Catheter malposition, catheter occlusion and being small for gestational age were risk factors for PICC-related phlebitis, while dexamethasone solution infiltration of catheters and innovative nursing interventions were protective factors. Venipuncture of the lower limbs is the most likely location to cause PICC-related phlebitis.

C10. An ultra-rare case of Hutchinson–Gilford progeria syndrome with severe aortic regurgitation due to bicuspid aortic valve in a 9-year-old girl

Abstract Background Hutchinson-Gilford progeria syndrome (HGPS) is an ultra-rare autosomal dominant that result in progressive premature aging syndrome. Cardiovascular diseases become the main cause of mortality including myocardial infarction, interstitial myocardial fibrosis, hypertension and calcification of the mitral and aortic valves. However, the relationship between HGPS and bicuspid aortic valve (BAV) has not been documented yet. Case Summary A 9-year-old girl with HGPS presented to the outpatient clinic with a complaint of shortness of breath since 5 years ago, especially when she did moderate physical activity. Chest pain and palpitation were denied. Her physical examination revealed short stature, thin, wrinkled skin, craniofacial disproportion with alopecia, shrunken facies and prominent scalp veins. There was failure to thrive and diastolic murmur grade 2/4 is heard on the aortic area. Laboratory test showed leukocytosis. Transthoracic echocardiogram showed severe aortic regurgitation due to calcified bicuspid aortic valve and mild mitral regurgitation. She was managed by conservative therapy because her parents were still considering the aortic valve repair procedure. Discussion The HGPS patient with severe aortic regurgitation due to BAV should be managed to reduce cardiovascular complications. Aortic valve repair is an interesting alternative to replacement managing aortic regurgitation due to BAV in young adults. Recently, advanced science about BAV disease and refinement of surgical techniques improved standardization of BAV repair procedure.

C10. An ultra-rare case of Hutchinson–Gilford progeria syndrome with severe aortic regurgitation due to bicuspid aortic valve in a 9-year-old girl

Abstract Background Hutchinson-Gilford progeria syndrome (HGPS) is an ultra-rare autosomal dominant that result in progressive premature aging syndrome. Cardiovascular diseases become the main cause of mortality including myocardial infarction, interstitial myocardial fibrosis, hypertension and calcification of the mitral and aortic valves. However, the relationship between HGPS and bicuspid aortic valve (BAV) has not been documented yet. Case Summary A 9-year-old girl with HGPS presented to the outpatient clinic with a complaint of shortness of breath since 5 years ago, especially when she did moderate physical activity. Chest pain and palpitation were denied. Her physical examination revealed short stature, thin, wrinkled skin, craniofacial disproportion with alopecia, shrunken facies and prominent scalp veins. There was failure to thrive and diastolic murmur grade 2/4 is heard on the aortic area. Laboratory test showed leukocytosis. Transthoracic echocardiogram showed severe aortic regurgitation due to calcified bicuspid aortic valve and mild mitral regurgitation. She was managed by conservative therapy because her parents were still considering the aortic valve repair procedure. Discussion The HGPS patient with severe aortic regurgitation due to BAV should be managed to reduce cardiovascular complications. Aortic valve repair is an interesting alternative to replacement managing aortic regurgitation due to BAV in young adults. Recently, advanced science about BAV disease and refinement of surgical techniques improved standardization of BAV repair procedure.

A novel homozygous synonymous variant further expands the phenotypic spectrum of POLR3A‐related pathologies

Pathogenic biallelic variants in POL3RA have been associated with different disorders characterized by progressive neurological deterioration. These include the 4H leukodystrophy syndrome (hypomyelination, hypogonadotropic hypogonadism, and hypodontia) and adolescent-onset progressive spastic ataxia, as well as Wiedemann-Rautenstrauch syndrome (WRS), a recognizable neonatal progeroid syndrome. The phenotypic differences between these disorders are thought to occur mainly due to different functional effects of underlying POLR3A variants. Here we present the detailed clinical course of a 37-year-old woman in whom we identified a homozygous synonymous POLR3A variant c.3336G>A resulting in leaky splicing r.[3336ins192, =, 3243_3336del94]. She presented at birth with intrauterine growth retardation, lipodystrophy, muscular hypotonia, and several WRS-like facial features, albeit without sparse hair and prominent scalp veins. She had no signs of developmental delay or intellectual disability. Over the years, above characteristic facial features, she showed severe postnatal growth retardation, global lipodystrophy, joint contractures, thoracic hypoplasia, scoliosis, anodontia, spastic quadriplegia, bilateral hearing loss, aphonia, hypogonadotropic hypogonadism, and cerebellar peduncles hyperintensities in brain imaging. These manifestations partially overlap the clinical features of the previously reported POLR3A-associated disorders, mostly mimicking the WRS. Thus, our study expands the POLR3A-mediated phenotypic spectrum and suggests existence of a phenotypic continuum underlying biallelic POLR3A variants.

Синдром Відемана — Раутенштрауха (неонатальний прогероїдний синдром): клінічне спостереження та короткий огляд літератури

Наведено спостереження синдрому Відемана — Раутенштрауха у дівчинки 2,5 року. Подібний стан є вкрай рідкісною патологією, етіологія якого до кінця не встановлена. Головними клінічними ознаками захворювання є прогероїдні риси, різка затримка анте- і післянатального росту, псевдогідроцефалія, ліпоатрофія (обличчя, кінцівки), гіпотрихоз, виступаючі вени на голові, характерна будова черепа обличчя та ін. Лікування тільки симптоматичне. Захворювання має прогресуючий перебіг та ранню летальність. Наведений перший опис клінічного випадку в Україні та короткий огляд літератури.

Obstructive Hydrocephalus in Children: Predictive Factors of Ventriculocisternostomy Dysfunction at the University Hospital Center of Conakry

The treatment of hydrocephalus is surgical and uses two (2) main methods to date: ventriculoperitoneal shunt (DVP) and endoscopic ventriculocisternostomy (VCS). The latter offers the advantage of avoiding the implantation of a foreign body (valve) in the body. However, there are sometimes dysfunctions that can lead to the evolutionary continuation of hydrocephalus. The objective of this study is to identify factors predictive of VCS dysfunction in cases of obstructive hydrocephalus in children at the University Hospital Center (CHU) in Conakry. This is a mixed analytical study of 32 cases of children aged 0-15 years who received VCS during the study period. Outcomes were evaluated according to Drake and Canadian Pediatric Neurosurgery Group clinical criteria. The hospital frequency was 17% and a sex ratio (M/F) of 1.13. Clinical signs were dominated by progressive macrocraniality (93.8%), bulging fontanel (84.4%), ectasia of scalp veins (68.8%). CSF leakage (9.4%) was the most frequent post-operative complication. We recorded one case of death. The success rate of CSF according to Drake's criteria was 56%. The factors often associated with the dysfunction of the VCS found in this study are essentially: age, bulging fontanelle, ectasia of the scalp veins, arachnoid adhesions, closure of the Sylvius aqueduct and pulsation of the bottom of the 3rd V. In the absence of a statistically significant relationship, it would be useful to analyse these parameters closely on a much larger sample.

Diagnosis and Management of Cerebral Venous Sinus Thrombosis With Vaccine-Induced Immune Thrombotic Thrombocytopenia.

Diagnosis and Management of Cerebral Venous Sinus Thrombosis With Vaccine-Induced Immune Thrombotic Thrombocytopenia.

16194 A GAPO syndrome case report: Identification of novel biallenic ANTXR1 variants cause GAPO syndrome

GAPO syndrome (GS) is a very rare disorder characterized by growth retardation, pseudoanodontia, alopecia and optic atrophy. We report a 20-year-old boy, except optic atrophy combined with a new discovered mutation. The patient was noticed to have abnormal facial features at birth, but no one knew what was exactly abnormality. He was discovered getting this syndrome since 12-year-old. On examination, the patient had short feature, universal alopecia, redundant skin, cafe-au-lait macules on the scalp, osteomalacia, and pseudoanodontia. He also had a typical face for GS including high and bossing forehead, puffy eyelids, depressed nasal bridge, cranofacial dysmorphia, thick everted lower lip, low-set ears, premature aging appearance and prominent dilated scalp veins. Primary and permanent teeth were formed but fail to erupt. The development of his mental and motor functional activities was not discovered abnormalities on examination. Laboratory examination was normal. The histopathologic pattern of the scalp skin described the epidermis had an atrophic malpighian layer, the epidermal ridges did not descend in the dermis and there was a dense proliferation of connective tissue admixed with infiltration of a chronic inflammatory cell. New mutations were discovered including a novel biallenic variants of ANTXR1: c.T1149 A (protein Y383X) and c.1143_1145del (protein Y383del) located both in exon 15 by whole exome sequencing. These variants are inherited from paternal indicated the auto recessive mode of inheritance. To date, only 6 mutations in ANTXR1 have been reported in GS. This is a first case of GS due to a novel biallenic ANTXR1 variants.

The Wiedemann-Rautenstrauch or Neonatal Progeroid Syndrome: Report of a Patient with Gingival Hyperplasia and Severe Anterior Open Bite

Introduction: The Wiedemann-Rautenstrauch syndrome (WRS) is a rare progeroid syndrome with an autosomal recessive pattern of inheritance. The main clinical features include severe intrauterine and postnatal growth failure, distinctive facial appearance, hydrocephaly, prominent scalp veins, absence of subcutaneous fat, sparse hair of the scalp, eyebrows, and eyelashes, generalized lipoatrophy, psychomotor delay, progressive neurological deterioration, and short life expectancy. Natal teeth and micrognathia are reported as the oral manifestations of this syndrome. Case Presentation: Here is the report of a 6.5-year-old female patient with clinical signs of WRS referred to the Department of Periodontology of Shiraz School of Dentistry with the chief complaint of toothache and gingival hyperplasia. Carious teeth were extracted, and excess gingival tissue was removed through a surgical procedure under general anesthesia. The patient was the first case with a concomitant severe anterior open bite. Conclusions: Therapies for WRS are symptomatic, requiring the coordinated efforts of a team of specialists. Dentists and oral surgeons can be recruited by pediatricians and family physicians to improve the quality of life of such patients.

Wormian Bones and Dilated Scalp Veins in an Infant With Epilepsy.

A three-months boy presented with recurrent seizures. On examination, he was fair, had dilated scalp veins, sparse hypopigmented hair, and was hypotonic. X-ray of the skull showed wormian bones. The child was diagnosed with Menkes disease. The manuscript aims to emphasize dilated scalp veins in diagnosis of Menkes disease.

Papilledema with Dilated Scalp Veins

Papilledema with Dilated Scalp Veins

Bi-allelic POLR3A Loss-of-Function Variants Cause Autosomal-Recessive Wiedemann-Rautenstrauch Syndrome

Wiedemann-Rautenstrauch syndrome (WRS), also known as neonatal progeroid syndrome, is a rare disorder of unknown etiology. It has been proposed to be autosomal-recessive and is characterized by variable clinical features, such as intrauterine growth restriction and poor postnatal weight gain, characteristic facial features (triangular appearance to the face, convex nasal profile or pinched nose, and small mouth), widened fontanelles, pseudohydrocephalus, prominent scalp veins, lipodystrophy, and teeth abnormalities. A previous report described a single WRS patient with bi-allelic truncating and splicing variants in POLR3A. Here we present seven additional infants, children, and adults with WRS and bi-allelic truncating and/or splicing variants in POLR3A. POLR3A, the largest subunit of RNA polymerase III, is a DNA-directed RNA polymerase that transcribes many small noncoding RNAs that regulate transcription, RNA processing, and translation. Bi-allelic missense variants in POLR3A have been associated with phenotypes distinct from WRS: hypogonadotropic hypogonadism and hypomyelinating leukodystrophy with or without oligodontia. Our findings confirm the association of bi-allelic POLR3A variants with WRS, expand the clinical phenotype of WRS, and suggest specific POLR3A genotypes associated with WRS and hypomyelinating leukodystrophy.

A Rare Case of Hutchınson-Gılford Progerıa Syndrome Wıth Early Dental Loss Wıthout Decay

Hutchinson-Gilford progeria syndrome (HGPS) is a rare autosomal recessive genetic disorder that occurs as a point mutation in the LMNA gene. It is a rare hereditary disorder, with approximately 100 cases reported in the medical literature. These patients and our case show features of aged appearance (pseudosenilism), loss of subcutaneous fat texture, growth retardation, sclerodermatous skin, ‘horse riding posture', bird-face appearance, beaked nose, high pitched voice, protruding knees and elbows, underweight, short stature, malformation of the teeth, micrognathia, hypodontia, malocclusion, craniofacial disproportion, atherosclerosis and cardiovascular disorders. Unlike typical findings of HGPS, diffuse alopecia and prominent scalp veins were not observed in our case. Patients with HGPS have an average life span of 13 years, owing to myocardial infarction and congestive heart failure and our case also has atherosclerosis and heart failure. Here, we report extra- and intraoral findings in a 24-year-old male patient with HGPS who came to our faculty with complaints about absence of teeth and psychological problems caused by absence of teeth and HGPS findings such as pseudosenilism, growth retardation and short stature. We have described necessary dental examinations and treatments for our patient and have reviewed the literature.

Fluctuant Mass on an Infant’s Scalp

A term infant has the following scalp examination [click on the video]. Of the options shown in Fig 1A (A, B, C, or D) of the top of an infant’s head, what is the most likely location of the involved area in this infant? Video. Click here to view the video. Figure 1A. Locations for potential collections that are exterior and interior to an infant’s skull. The video of this newborn shows a moderate-to-large fluctuant mass gathered in the dependent portion of the neonate’s scalp. Upon gentle tapping of the boggy collection, there is a clearly visible fluid wave. This finding is most consistent with a subgaleal hemorrhage. Subgaleal hemorrhage is a serious, potentially fatal event in a newborn. It is caused by the rupture of large, bridging, emissary veins that connect the scalp veins to the intracranial dural sinuses. When these veins rupture, blood accumulates between the periosteum and the galeal aponeurotica, a large potential space composed of loose connective tissue. This space extends without restriction across the cranium and can hold as much as 260 mL of blood. (1) (Note: The average total blood volume in a term infant is 80–90 mL/kg.) A hemorrhage of …

Sinus pericranii occipital : à propos d’une situation inhabituelle et revue de la littérature

The sinus pericranii refers to a set of clinical presentations that share a pathological communication between the scalp veins and the underlying cranial venous sinus. The nature of this connection ranges from the simple dilatation of the emissary veins, to wide connections through a calvarial bone loss leaving almost the cranial venous sinus in direct contact with the subcutaneous tissue. The authors present the case of an occipital pericranii sinus of intraoperative discovery. Congenital, post-traumatic or spontaneous, this anomaly is most often frontal and located on or close to the midline. The usual clinical presentation is that of a soft mass that empties to the pressure while standing, while it fills in all situations that increase the intracranial pressure (Valsalva maneuver …). The diagnosis is not always easy to establish, and relies on a bundle of clinical and radiological arguments. Through a review of the literature we propose to focus on the clinical features, diagnostic means and therapeutic options of this rare entity.

The Impact of Blood Sampling Site on Pain Score in Preterm Infants: A Crossover Randomized Clinical Trial

Background Blood sampling is a usual and painful procedure on preterm infant. Repeating painful procedures may affect the process of normal brain development and Pain management is important for nurses. This study was conducted to evaluate and compare pain score in two sites of blood sampling in preterm infants. Materials and Methods Blood sampling is a usual and painful procedure on preterm infant. Repeating painful procedures may affect the process of normal brain development and Pain management is important for nurses. This study was conducted to evaluate and compare pain score in two sites of blood sampling in preterm infants. Results The pain score was significantly higher while sampling was conducted from hand veins compared to scalp veins (p=0.001).The pain score was significantly higher in preterm infants with lower gestational age (28-30 weeks) than the infants with 30-32 weeks of gestation(p=0.048). Conclusion The pain score in preterm infants according to ALPS-Neo method was significantly higher while sampling was conducted from hand veins compared to scalp veins. Preterm infants with lower gestational age had also higher pain score.

Diffuse Venous Thrombosis

A 29-year-old man presented with an 8-week history of lower extremity edema, neck vein distention, facial swelling, and headache. He had a 3-year history of paroxysmal nocturnal hemoglobinuria (PNH) managed with eculizumab. Computed tomography (CT) of the abdomen and pelvis revealed bilateral external iliac and common femoral venous occlusions with right-sided varicocele (Figure, A ). Computed tomography of the chest demonstrated bilateral obstruction of the internal jugular veins, innominate veins, superior vena cava (SVC), and collateralization (Figure, B). Magnetic resonance venography of the head showed thrombosis of the superior sagittal sinus associated with extensive collateralization within the scalp veins (Figure, C). Anticoagulation was started and angioplasty of the SVC was performed. Allogenic bone marrow transplantation was offered. Paroxysmal nocturnal hemoglobinuria is an acquired disorder affecting progenitor stem cells and thus all cell linages.1Devalet B. Mullier F. Chatelain B. Dogne J.M. Chatelain C. Pathophysiology, diagnosis, and treatment of paroxysmal nocturnal hemoglobinuria: a review.Eur J Haematol. 2015; 95: 190-198Crossref PubMed Scopus (68) Google Scholar A mutation of the PIGA gene results in a deficiency of the glycosyl phosphatidyl inositol anchor where CD55 and CD59 attach. This renders the PNH clonal cells prone to complement-mediated hemolysis with subsequent release of prothrombotic factors, nitric oxide depletion, and platelet activation leading to thrombosis, which is the leading cause of death.1Devalet B. Mullier F. Chatelain B. Dogne J.M. Chatelain C. Pathophysiology, diagnosis, and treatment of paroxysmal nocturnal hemoglobinuria: a review.Eur J Haematol. 2015; 95: 190-198Crossref PubMed Scopus (68) Google Scholar, 2Cornell L.F. Sacco K.A. Chirila R.M. 60-Year-old woman with headache and fatigue.Mayo Clin Proc. 2017; 92: e121-e125Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 3Hill A. Kelly R.J. Hillmen P. Thrombosis in paroxysmal nocturnal hemoglobinuria.Blood. 2013; 121 (quiz 5105): 4985-4996Crossref PubMed Scopus (292) Google Scholar Venous thromboses occur more often than arterial, and any site may be affected.4Brodsky R.A. Paroxysmal nocturnal hemoglobinuria.Blood. 2014; 124: 2804-2811Crossref PubMed Scopus (323) Google Scholar Because abdominal and cerebral veins are frequently involved, Budd-Chiari syndrome is the most common thrombotic event and superior sagittal sinus thrombosis the most common neurologic complication.3Hill A. Kelly R.J. Hillmen P. Thrombosis in paroxysmal nocturnal hemoglobinuria.Blood. 2013; 121 (quiz 5105): 4985-4996Crossref PubMed Scopus (292) Google Scholar, 4Brodsky R.A. Paroxysmal nocturnal hemoglobinuria.Blood. 2014; 124: 2804-2811Crossref PubMed Scopus (323) Google Scholar Anticoagulation and eculizumab are required, and thrombolysis or angioplasty may be used for life-threatening thromboses.1Devalet B. Mullier F. Chatelain B. Dogne J.M. Chatelain C. Pathophysiology, diagnosis, and treatment of paroxysmal nocturnal hemoglobinuria: a review.Eur J Haematol. 2015; 95: 190-198Crossref PubMed Scopus (68) Google Scholar, 3Hill A. Kelly R.J. Hillmen P. Thrombosis in paroxysmal nocturnal hemoglobinuria.Blood. 2013; 121 (quiz 5105): 4985-4996Crossref PubMed Scopus (292) Google Scholar Bone marrow transplantation is offered to patients who fail eculizumab, as in our case.2Cornell L.F. Sacco K.A. Chirila R.M. 60-Year-old woman with headache and fatigue.Mayo Clin Proc. 2017; 92: e121-e125Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar