9 The main risk factors for CVT include prethrombotic conditions such as protein C and S deficiency, factor V Leiden, prothrombin and methylene tetrahydrofolate reductase mutation,

oral contraceptive pills, pregnancy, malignancy, infection, and head injury. Three major signs and symptoms of CVT are isolated intracranial hypertension (characterized by headache, vomiting and papillary edema), focal syndromes such as seizure and focal neurological deficits, and encephalopathy characterized by stupor and coma.10 Headache is the most common symptom of CVT. It is more common in females than in males. Headache onset is gradual and usually Inhibitors,research,lifescience,medical localized. The site of headache is not closely related to the localization of the involved sinuses.11 Sometimes headache is accompanied by aura-like migraine headache. The cornerstone of APS treatment is anticoagulation with heparin or warfarin. Currently, new generations of anticoagulants like pradaxa and xarelto are available as well. Alternative agents, especially in catastrophic conditions are Inhibitors,research,lifescience,medical prostacyclins, glucocorticoids, rituximab, and thrombolytic drugs like streptokinase or tissue plasminogen activator inhibitor.12 Tissue plasminogen activator inhibitor is a thrombolytic agent Inhibitors,research,lifescience,medical that was approved by FDA for the treatment of ischemic stroke. It binds to fibrin in thrombotic clot, and then converts

plasminogen to plasmin. There are not randomized clinical trials comparing systemic and local thrombolytic therapies.13 Death (15%), and intracranial and extracranial hemorrhage are the Inhibitors,research,lifescience,medical major side effects of treatment with tissue plasminogen activator inhibitor. There are

data showing that for CVT treatment local thrombolytic agents are more effective than systemic heparin anticoagulation. There are few case reports about tissue plasminogen activator inhibitor injection in the treatment of APS.14 Given the APS pathogenesis and presence of impaired fibrinolysin system in this KPT-330 supplier disease, we will probably Inhibitors,research,lifescience,medical see some changes in treatment strategy of this syndrome in the future.15 Conclusion The present case was lupus-induced secondary APS that was diagnosed first time in pregnancy. The main problem of the case was CVT. Due to early diagnosis and intervention with tissue plasminogen activator inhibitor her general condition improved and she has no major problems. Conflict of Interest: None declared
Nerve root compression in the lumbar disk syndrome Ribonucleotide reductase is a common cause of acute, chronic and recurrent low back pain accompanied by radiating pain to the lower extremity superimposed by sensory motor impairment.1 Most patients with disk-induced radicolopathy respond to conservative management. When radiculopathy occurs, several features including pain distribution, reflex changes, distribution of weakness and sensory alteration provide reliable information to enable a clinician to localize the level of disk protrusion or root irritation.