TEN Neurologia Practice Questions - TEN - Título De Especialista Em Neurologia (Academia Brasileira De Neurologia AMB) Exam

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A 29-year-old woman on oral combined contraceptives presents with a 5-day history of progressive headache, nausea, and recent onset of left-sided focal motor seizures with secondary generalization. Cranial MRI and MR venography demonstrate extensive thrombosis of the superior sagittal sinus and right transverse sinus with a small cortical venous hemorrhagic infarction in the right parietal lobe. What is the first-line therapeutic management?

Full therapeutic anticoagulation with low-molecular-weight heparin (LMWH) or unfractionated heparin, despite the presence of intracranial hemorrhage. Immediate surgical decompressive craniectomy combined with direct sinus thrombectomy. Intravenous dexamethasone to control vasogenic edema and antiepileptic therapy alone without anticoagulation. Dual antiplatelet therapy with aspirin and clopidogrel while avoiding systemic anticoagulation due to hemorrhagic transformation.

Correct Answer:

Full therapeutic anticoagulation with low-molecular-weight heparin (LMWH) or unfractionated heparin, despite the presence of intracranial hemorrhage.

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