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Dr. Andrew Rynne

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Exp 50 years

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What causes blood clots in brain with positive result for barr virus?

My daughter tested positive for the barr virus (mono). After 5 days in the hospital and terrible headaches they ordered an mri showing small blood clots in her brain. Cerebral vein thrombosis. She has since had blood tests done that have come back abnormal. She is on warafin. I have been looking for information connecting the two. Mono and clots. She is only 21, an athlete was in great shape before all this. She has lost 20 pounds because of the nausea and now is getting little sleep. We have Kaiser Insurance. We were told to wait 6 weeks for another blood test and in the meantime take oxycoden for the headaches. In 6 weeks if the blood test are still abnormal he will refer us to a hematologist. My question is should we seek a 2nd opinion and is there anything else we should be doing for her?
Mon, 8 Apr 2019
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Neurologist 's  Response
Hi,

Hypercoagulable state is a condition which commonly comes about because of infectious states, dehydration, and other metabolic disorders. The blood clots are referred to as sinus venous thrombosis or venous thrombosis and they are in the venous circulation of her body...which is not a bad thing compared to if they would be on the arterial side in which case she may have suffered acute strokes....not to minimize the gravity of the current situation....she's got a bit of work to do to get normal....but she's not lost any neurological function due to the clots....just slowed her down...and giving her some mild headaches, I'm sure. Since your daughter has been diagnosed with EBV...then, that is likely the most plausible explanation for her blood clots, severe headaches, cloudy thinking, etc.

The good news is that she'll get better...she's on an oral anticoagulant though current guidelines actually recommend she NOT be given orals. If she's converted to warfarin then, I'd ask the doctor if he'd consider something instead like Eliquis (newer version of warfarin such that no INR testing is really needed, less bleeding complications overall). I'm not sure why they chose oxycodone for headaches.

CVT headaches have been shown to have pathophysiology very similar to migraine and they do respond to standard migraine regimens. She may benefit from IV DHE (dihydroergotamine) or triptans even though she can't take the medication continuously.

Now, if they keep giving her the opiate drugs....I'm afraid she might run into some medication rebound or overuse syndrome which will give her even more headaches.

You may find better medication choices for the headaches from a headache specialist. I am not sure what the hematologist move is going to accomplish.

Her status of resolution will be dependent upon how quickly the venous clots come down. Other details have to be explained to your future for the future and another blood testing should be done now that this has happened.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Dariush Saghafi, Neurologist
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