Acute sinovenous thrombosis with multiple etiologic factors

Abstract

In childhood; the incidence of intracranial thrombosis is 2.5-2.7/100000. They may present with different symptoms according to the location and size of the occluded vessel and age of the patient. In most cases; cranial imaging is necessary to confirm the lesion. Pediatric cerebrovascular thrombosis may be related to more than one etiologic factor so detailed evaluation is mandatory. A thirteen-year-old boy presented to our emergency room with a complaint of seizure. His cranial imaging showed thrombosis in left transverse-sigmoid sinuse. His father had been diagnosed to have deep venous thrombosis. In our case and in his father; protein S levels were found as 11.9% and 10.6% (N: % 80-120) respectively and they were started on anticoagulation therapy. Our patient's homocsyteine level was 15.5 mmol/lt N: 0-12). His methylene-tetrahydrofolate reductase thermolabile enzyme (C677T) mutation was found homozygous. He was also started on oral folic acid therapy. A year after his first presentation, his protein S level was 16% and homocysteine level was 7.5 mmol/ lt. His last cranial imaging showed no progresssion in the prior lesion and no new lesion.