{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T09:54:38Z","timestamp":1762509278100,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and clinical significance: Tranexamic acid (TXA) is commonly used for menorrhagia. Common side effects include diarrhoea, nausea, and vomiting. However, more serious and rare side effects, including embolism, thrombosis, and seizures, are less commonly considered. Case presentation: We report the case of a 39-year-old woman of Asian origin who presented after a first-time seizure while driving, following starting tranexamic acid for menorrhagia seven days prior. She complained of a headache, nausea, neck stiffness, floaters, and blurred vision. Her lactate was elevated on presentation. On examination there were no neurologic abnormalities. A computed tomography (CT) head scan showed acute haemorrhagic foci along the left temporal lobe. This prompted a CT venography, which showed filling defects in the left transverse and sigmoid sinuses, in keeping with cerebral venous sinus thrombosis. MRI of the head further showed a blooming artefact, indicating secondary thrombosis of the lateral tentorial sinus on the left side extending into the vein of Labbe. Following the diagnosis of cerebral venous sinus thrombosis, the patient was started on regular levetiracetam as well as a therapeutic dose of low molecular weight heparin. Since the initial episode, she has been seizure-free for over three months now. Conclusions: This case highlights the importance of considering less common side effects of tranexamic acid in patients who are taking TXA and are presenting with first-time seizures and headaches. These patients should be monitored for embolic-related intracranial events. A careful diagnostic approach, including cerebrovascular imaging, is essential for an accurate diagnosis and effective treatment.<\/jats:p>","DOI":"10.3390\/reports8040210","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T13:54:41Z","timestamp":1760968481000},"page":"210","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Rare Case of First-Time Seizure Induced by Cerebral Venous Sinus Thrombosis Following the Use of Tranexamic Acid for Menorrhagia"],"prefix":"10.3390","volume":"8","author":[{"given":"Jennifer","family":"Bandt","sequence":"first","affiliation":[{"name":"General\/Acute Medical Unit, Bolton NHS Foundation Trust, Bolton BL4 0JR, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5791-301X","authenticated-orcid":false,"given":"Emmanuel O.","family":"Oisakede","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Leeds Teaching Hospitals Trust, Leeds LS1 3EX, UK"},{"name":"Department of Health Research, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Walker","sequence":"additional","affiliation":[{"name":"General\/Acute Medical Unit, Bolton NHS Foundation Trust, Bolton BL4 0JR, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.xfre.2023.10.003","article-title":"The efficacy of medical management of leiomyoma-associated heavy menstrual bleeding: A mini review","volume":"5","author":"Barseghyan","year":"2024","journal-title":"F&S Rep."},{"key":"ref_2","unstructured":"Chauncey, J.M., and Wieters, J.S. (2025, September 07). Tranexamic Acid. [Online] Nih.gov, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK532909\/."},{"key":"ref_3","first-page":"50-e18","article-title":"The current place of tranexamic acid in the management of bleeding","volume":"70","author":"Hunt","year":"2014","journal-title":"Anaesthesia"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/S0140-6736(17)30638-4","article-title":"Effect of Early Tranexamic Acid Administration on mortality, hysterectomy, and Other Morbidities in Women with post-partum Haemorrhage (WOMAN): An international, randomised, double-blind, placebo-controlled Trial","volume":"389","author":"Shakur","year":"2017","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1186\/s13054-021-03799-9","article-title":"Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: A systematic review and meta-analysis","volume":"25","author":"Murao","year":"2021","journal-title":"Crit. Care"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1124\/jpet.301.1.168","article-title":"Tranexamic Acid, a Widely Used Antifibrinolytic Agent, Causes Convulsions by a \u03b3-Aminobutyric AcidA Receptor Antagonistic Effect","volume":"301","author":"Schlag","year":"2002","journal-title":"J. Pharmacol. Exp. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4654","DOI":"10.1172\/JCI63375","article-title":"Tranexamic acid concentrations associated with human seizures inhibit glycine receptors","volume":"122","author":"Lecker","year":"2012","journal-title":"J. Clin. Investig."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e210884","DOI":"10.1001\/jamasurg.2021.0884","article-title":"Association of intravenous tranexamic acid with thromboembolic events and mortality","volume":"156","author":"Taeuber","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1186\/s13256-020-02545-z","article-title":"Bilateral pulmonary embolism while receiving tranexamic acid: A case report","volume":"14","author":"Ijaopo","year":"2020","journal-title":"J. Med. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"100882","DOI":"10.1016\/j.eclinm.2021.100882","article-title":"Oral tranexamic acid and thrombosis risk in women","volume":"35","author":"Meaidi","year":"2021","journal-title":"EClinicalMedicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"237","DOI":"10.4103\/0972-5229.118443","article-title":"Acute arterial thrombosis associated with inadvertent high dose of tranexamic acid","volume":"17","author":"Upadhyay","year":"2013","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"111008","DOI":"10.1016\/j.injury.2023.111008","article-title":"Does tranexamic acid increase venous thromboembolism risk among trauma patients? A prospective multicenter analysis across 17 level I trauma centers","volume":"54","author":"Knowlton","year":"2023","journal-title":"Injury"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jocn.2018.09.007","article-title":"Cerebral venous thrombosis: A case series and a neuroimaging review of the literature","volume":"58","author":"Diacinti","year":"2018","journal-title":"J. Clin. Neurosci."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1111\/j.1538-7836.2007.02717.x","article-title":"Evaluation of aprotinin and tranexamic acid in different and models of fibrinolysis, coagulation and thrombus formation","volume":"5","author":"Sperzel","year":"2007","journal-title":"J. Thromb. Haemost."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.thromres.2014.11.012","article-title":"Tranexamic acid\u2014An old drug still going strong and making a revival","volume":"135","author":"Tengborn","year":"2015","journal-title":"Thromb. Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception (1995). Venous thromboembolic disease and combined oral contraceptives: Results of international multicentre case-control study. Lancet, 346, 1575\u20131582.","DOI":"10.1016\/S0140-6736(95)91926-0"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/S0887-8994(96)00290-1","article-title":"Iron deficiency: A cause of stroke in infants and children","volume":"16","author":"Hartfield","year":"1997","journal-title":"Pediatr. Neurol."},{"key":"ref_18","unstructured":"Tadi, P., Behgam, B., and Baruffi, S. (2025, April 25). Cerebral Venous Thrombosis. [Online] PubMed, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459315\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1159\/000079939","article-title":"Cerebral Venous Infarction: The Pathophysiological Concept","volume":"18","author":"Schaller","year":"2004","journal-title":"Cerebrovasc. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1002\/epi4.12229","article-title":"Seizure in cerebral venous and sinus thrombosis","volume":"3","author":"Habibabadi","year":"2018","journal-title":"Epilepsia Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1161\/01.STR.0000117571.76197.26","article-title":"Prognosis of Cerebral Vein and Dural Sinus Thrombosis","volume":"35","author":"Ferro","year":"2004","journal-title":"Stroke"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"2Saposnik, G., Barinagarrementeria, F., Brown, R.D., Bushnell, C.D., Cucchiara, B., Cushman, M., deVeber, G., Ferro, J.M., and Tsai, F.Y. (2011). Diagnosis and Management of Cerebral Venous Thrombosis. Stroke, 42, 1158\u20131192.","DOI":"10.1161\/STR.0b013e31820a8364"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hu, S., Lee, H., Zhao, H., Ding, Y., and Duan, J. (2022). Inflammation and Severe Cerebral Venous Thrombosis. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.873802"},{"key":"ref_24","unstructured":"NICE (2025, April 25). Overview|Venous Thromboembolic Diseases: Diagnosis, Management and Thrombophilia Testing|Guidance|NICE. Available online: https:\/\/www.nice.org.uk\/guidance\/ng158."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.nec.2018.06.011","article-title":"Management of Venous Sinus Thrombosis","volume":"29","author":"Sader","year":"2018","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_26","unstructured":"NICE (2025, September 25). Diagnosis and Assessment of Epilepsy|Epilepsies in Children, Young People and Adults|Guidance|NICE. Available online: https:\/\/www.nice.org.uk\/guidance\/ng217\/chapter\/1-Diagnosis-and-assessment-of-epilepsy."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1002\/cncr.22199","article-title":"Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate","volume":"107","author":"Meirow","year":"2006","journal-title":"Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Tan, Y.H., and Lethaby, A. (2013). Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding. Cochrane Database Syst. Rev., 11.","DOI":"10.1002\/14651858.CD010241.pub2"}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/210\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T14:25:02Z","timestamp":1760970302000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,20]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["reports8040210"],"URL":"https:\/\/doi.org\/10.3390\/reports8040210","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,20]]}}}