Four-extremity deep venous thrombosis on a brain injury rehabilitation unit: case report

Abstract

Lower extremity deep venous thrombosis (LE DVT) is a fairly common condition among brain injury rehabilitation patients, occurring in up to 20% of all admissions. Upper extremity deep venous thrombosis (UE DVT) is less common. However, its incidence is expected to increase due to the increasing usage of central venous catheterization (CVC). This paper reviews the course of treatment of a patient with recurrent malignant meningioma who was found to have fourextremity deep venous thrombosis on a baseline screening duplex Doppler ultrasonography at admission to an inpatient brain injury rehabilitation unit. The need for tumor embolization followed by surgical resection was felt to preclude chemical prophylaxis for DVT despite the significant risk factors of; age > 60, immobility, quadriplegia, surgery with anesthesia > 30 minutes, and diagnosis of cancer. Aggressive anticoagulation with close clinical monitoring allowed for successful participation in a full rehabilitation with only a brief delay. The appropriate treatment of this patient is discussed in light of the latest research findings. Recommendations for future treatment protocols and research are made.