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Rapidly progressive glomerulonephritis — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesRapidly progressive glomerulonephritisSCE Acute Medicine

CT venography confirms superior sagittal sinus thrombosis in a 33-year-old with headache and focal seizure. CT also shows a 2.5 cm haemorrhagic venous infarct. Platelets and coagulation are normal. What is the best antithrombotic strategy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Start full-dose heparin anticoagulation despite the secondary intracerebral haemorrhage

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · A = shown as D · B = shown as E

D is correct. NICE recommends full-dose anticoagulation for cerebral venous sinus thrombosis, initially with heparin, including when there is secondary intracerebral haemorrhage. The haemorrhage results from venous congestion and does not by itself reverse the treatment principle. A leaves the propagating thrombosis untreated. B is inadequate therapy. C is not routine first-line management and has substantial bleeding risk. E misapplies the arterial ICH BP pathway to a venous thrombosis. Seizures are treated, provoking factors sought and longer-term anticoagulation selected after the acute heparin phase.

Reference: NICE NG128: cerebral venous sinus thrombosis: https://www.nice.org.uk/guidance/NG128/chapter/recommendations