**2. Clinical study**

We present a set of eight cases of women with a diagnosed cerebral venous thrombosis. The age scope of the group was 18.7 – 39.3 years of age, with mean of 28.1 years. The patients were hospitalized between April 2004 and October 2005. All patients were referred to CT / MRI and DSA venography examinations. Five of the women were treated with a therapeutic dose of low-molecular heparins (LMWH) only, with a transfer to warfarin treatment, other three patients underwent an interventional treatment with local thrombolysis with Actilyse® (rt-PA), following an ineffective LMWH application.

We have evaluated all medical records of the patients, the patients were examined physically and we have taken a detailed history record. Seven patients were using thirdgeneration hormonal contraceptives with gestagens, one patient was using purely gestagen contraceptives, none of the patients smoked.

## **3. Laboratory examinations**

All patients were referred for blood tests in order to define the presence of thrombophilic states. The blood samples were collected and tested prior to the onset of an anticoagulation treatment, and 3-6 months following a thrombotic event.

causes an increase of the prothrombin level and contributes to elevation of the risk of

Deficit of the antithrombin III is a disorder with most prothrombotic effects. The risk of developing a thromboembolic disease during life is 70-80% in carriers in the heterozygous form (homozygous carriers suffer from a lethal thromboembolic event usually already during childhood). AT III is a polypeptide synthetized in hepatocytes with an increased half-time (65 hours). Apart from its effect on thrombin, AT III is also able to activate factors Xa, IXa, VIIa and plasmin. The activation of antithrombin III is increased up to 40 000 times with heparin binding. The deficit of AT III is caused by numerous point mutations, deletion

Homocysteine is contained in plasma at concentrations of 5 – 16 mol/l. Congenital hyperhomocysteinemia may be caused by a number of enzymatic defects. Clinical manifestations may be strengthened with a deficit of B6 and B12 vitamins, folic acid or during a treatment with methotrexate. Thrombophilia caused by hyperfibrinogenemia and

Large population studies aimed at the relations between hormonal contraceptives and deep vein thrombosis have been performed. The increased risk was described mainly in patients using third-generation gestagens. Moreover, the identified risk of thrombosis in patients using hormonal contraceptives with thrombophilia is higher than what would correspond with a simple addition of risks. This finding confirms the theory that the procoagulation

The problems of cerebral venous thrombosis in women in fertile age, who are the users of hormonal contraceptives have been studied in several trials including only a small number

The aim of our study was to analyse cases of CVT in relation to sex, age, use of hormonal contraceptives and thrombophilic states, in correlation with CT, MRI and DSA findings and

We present a set of eight cases of women with a diagnosed cerebral venous thrombosis. The age scope of the group was 18.7 – 39.3 years of age, with mean of 28.1 years. The patients were hospitalized between April 2004 and October 2005. All patients were referred to CT / MRI and DSA venography examinations. Five of the women were treated with a therapeutic dose of low-molecular heparins (LMWH) only, with a transfer to warfarin treatment, other three patients underwent an interventional treatment with local thrombolysis with

We have evaluated all medical records of the patients, the patients were examined physically and we have taken a detailed history record. Seven patients were using thirdgeneration hormonal contraceptives with gestagens, one patient was using purely gestagen

All patients were referred for blood tests in order to define the presence of thrombophilic states. The blood samples were collected and tested prior to the onset of an anticoagulation

and insertion, and the inheritance is mostly autosomally dominant.

dysfibrinogenemia is observed significantly less frequently.

mechanisms are mutually strengthened in these women.

with clinical neurological findings.

**2. Clinical study** 

of patients. The results are in many cases misleading and inconsistent.

Actilyse® (rt-PA), following an ineffective LMWH application.

treatment, and 3-6 months following a thrombotic event.

contraceptives, none of the patients smoked.

**3. Laboratory examinations** 

thrombosis up to threefold level.

APC resistance was tested with the use of factor V deficient plasma (Coatest® APC resistance Chromogenix). The test presents almost 100% sensitivity and specificity in detection of factor V mutations (Leiden). Patients with APC ratio below 1.86 were tested with PCR analysis for the presence of FV:Q506 allele. We have also chromatogenously determined the levels of protein C, antithrombin III (AT III), prothrombin, heparin II cofactor and plasminogen. Protein S was determined immunologically, as a free form of protein S.

In order to determine the complex mutations of FV 1691 G-A, prothrombin 20210 G-A and MTHFR 677 C-T, we used specific, polymerase chain reaction (MS PCR), according to the works of Austrian authors Endler et al. This method is a single-tube PCR technique based upon the use of allele-specific primers, differing mutually in 8-10 pairs of bases (bp). The subsequent amplification was carried out in accordance with the protocol, which was optimised for thermocycler Perkin Elmer 2400. Following the initial 10-minute denaturation at 95°C, 34 cycles follow, consisting of separation of DNA chains for 1 min at 95°C , annealing primers for 2 min at 56°C and DNA synthesis for 1 min at 72°C. After completion, final elongation was carried out for 7 min at 72°C, followed with cooling to 4°C. To separate the PCR products we used electrophoresis on Spreadex 400 gel (Elchrom Scientific), which enables separation of products up to 400 pb, with high resolution. The results were reviewed on UV review table at 254 nm, the photo documentation was obtained using a yellow filter with Mitsubishi camera enabling digital recording.
