Clomipramine Fatal cerebral thrombosis: case report

An agitated , depressed state In a 61-year-old woman did not improve with oral antidepressants and electroconvulsive therapy. Medical history was remarkable for thrombosis of the veins of the right leg and cardiac failure controlled with digitalis ,

On examination she had a systolic apical murmur and a resonant chest percussion Enlargement of the left ventricle was observed with a chest radiograph On day 273 after admiSSion the patient received InfUSions of clomipramine SOmg In SOOml Ringer's solution On day 274 she vomited, had a seizure and subsequently became comatose She died on day 27S and CT scan on the same day revealed haemorrhage In the left hemisphere

Autopsy demonstrated intracerebral haemorrhage of the left hemisphere with oedema , complete occlusion of the superficial cerebral veins, the superior longitudinal Sinus , the right lateral sinus and the right SigmOid sinus and partial occlusion of the left SigmOid sinus and the left lateral sinus

'This case draws attention to the importance of antithrombotic prophylaxes during treatment with infusions of antidepressants . .. '.

Elkmeler G Kuhlmann R GaSlpar \ ' Thrombos,s

of cerebra' \elns follo~""'lng rnlra"enOU$ aDollca:IOf'1

of clomipramine Journal of "'eurolog.

"'eurosurgery and Psychlalry 51 1461 ,"0. 1988