神経疾患と深部静脈血栓症

抄録

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in a vein, usually in the legs or pelvis. When DVT occurs, urgent care is required. Here, we describe the diagnosis and treatment of DVT in patients with neurological disease.

Stroke and DVT

Patients with stroke may lose the ability to maintain a sitting position, stand, or walk due to sudden hemiplegia or quadriplegia. They may be forced to remain in bed during the acute period, which can make them more susceptible to the development of DVT in the leg on the affected side. Anticoagulant therapy may also lead to the concurrent prevention of DVT depending on the type of cerebral infarction, especially in cases of cardiogenic cerebral embolism, and care is taken in the selection and dosage of the anticoagulant.

Cerebral infarction from DVT

It is important to understand that DVT can cause cerebral infarction. Emboli are sometimes produced in the cerebral arteries when there is a right–to–left shunt due to the existence of a patent foramen ovale, interatrial septal aneurysm, pulmonary arteriovenous fistula, or other condition. During diagnosis, the presence of a right–to–left shunt is confirmed with transesophageal echocardiography.

Other neurological diseases and DVT

The frequency of DVT also increases in conditions where lower limb paralysis is seen, such as peripheral neuropathy or neurodegenerative disease. Unlike stroke, the onset is not sudden and the progressive nature makes the initial determination difficult. DVT can occur due to decreased physical activity from staying in bed or lower limb paralysis cause by secondary impairment to venous return. Consequently, regular evaluation and prevention of DVT is important in patients with neurological disease who have paralysis.

Conclusion

Early discovery of DVT and appropriate treatment are important in patients with neurological disease.