Reversible diencephalic dysfunction as presentation of deep cerebral venous thrombosis due to hyperhomocysteinemia and protein S deficiency: Documentation of a case

Kaukab Maqbool Hassan; Dheeraj Kumar

doi:10.4103/0976-3147.112767

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Case Report

4 (

); 193-196

doi:

10.4103/0976-3147.112767

Reversible diencephalic dysfunction as presentation of deep cerebral venous thrombosis due to hyperhomocysteinemia and protein S deficiency: Documentation of a case

Kaukab Maqbool Hassan, Dheeraj Kumar

Department of Neurology, Command Hospital, Alipore, Kolkata, India

Address for correspondence: Col K M Hassan Department of Neurology, Command Hospital Alipore, Kolkata ‑ 700 027 India kaukabm.hassan@gmail.com

Journal of Neurosciences in Rural Practice

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Abstract

ABSTRACT

A 45‑year‑old man presented with global headache, vomiting and abnormal behavior after cross‑country run at high altitude. There was no seizure, loss of consciousness, fever or head injury. He was conscious, abulic and uncooperative with normal vitals. There was no focal neurological deficit. Non contrast computed tomography scan of head was normal. Magnetic resonance imaging of brain showed venous infarct in bilateral thalami, left basal ganglia and periventricular white matter. Magnetic resonance venography revealed thrombosis involving internal cerebral veins, septal veins, thalamostriate veins, vein of Galen and proximal portion of straight sinus. His condition steadily improved on low molecular weight heparin bridged with oral anticoagulation for one year. At two months, serum homocysteine was 31.51 μmol/l (5.46‑16.2 μmol/l) and protein S was 49.00% (77‑143.00%). He received methylcobalamin, pyridoxine and folic acid. After 16 months, he was asymptomatic with partially recanalized deep cerebral veins and serum homocysteine falling to 16.50 μmol/l (5.46‑16.2 μmol/l).

Keywords

Deep cerebral venous thrombosis

headache

hyperhomocysteinemia

protein S deficiency

vasogenic edemae

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Conflict of Interest

None declared

References

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[1] Bousser M. G., Ferro J. M., . Cerebral venous thrombosis: An update. Lancet Neurol. 2007;6:162-70.
[Google Scholar]

[2] Martinelli I, Battaglioli T, Pedotti P, Cattaneo M, Mannucci P. M., . Hyperhomocysteinemia in cerebral vein thrombosis. Blood. 2003;102:1363-6.
[Google Scholar]

[3] Ventura P, Cobelli M, Marietta M, Panini R, Rosa M. C., Salvioli G, . Hyperhomocysteinemia and other newly recognized inherited coagulation disorders (factor V leiden and prothrombin gene mutation) in patients with idiopathic cerebral vein thrombosis. Cerebrovasc Dis. 2004;17:153-9.
[Google Scholar]

[4] Basnyat B, Cumbo T. A., Edelman R, . Acute medical problems in the Himalayas outside the setting of altitude sickness. High Alt Med Biol. 2000;1:167-74.
[Google Scholar]

[5] Spearman M. P., Jungreis C. A., Wehner J. J., Gerszten P. C., Welch W. C., . Endovascular thrombolysis in deep cerebral venous thrombosis. AJNR Am J Neuroradiol. 1997;18:502-6.
[Google Scholar]

[6] Saposnik G, Barinagarrementeria F, Brown R. D., Bushnell C. D., Cucchiara B, Cushman M, et al . Diagnosis and Management of Cerebral Venous Thrombosis: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2011;42:1158-92.
[Google Scholar]

[7] Gladstone D. J., Silver F. L., Willinsky R. A., Tyndel F. J., Wennberg R, . Deep cerebral venous thrombosis: An illustrative case with reversible diencephalic dysfunction. Can J Neurol Sci. 2001;28:159-63.
[Google Scholar]

[8] Crawford S. C., Digre K. B., Palmer C. A., Bell D. A., Osborn A. G., . Thrombosis of the deep venous drainage of the brain in adults: Analysis of seven cases with review of the literature. Arch Neurol. 1995;52:1101-8.
[Google Scholar]

[9] Leys D, Cordonnier C, . Cerebral venous thrombosis. Ann Indian Acad Neurol. 2008;11:S79-87.
[Google Scholar]

[10] Burneo J. G., Elias S. B., Barkley G. L., . Cerebral venous thrombosis due to protein S deficiency in pregnancy. Lancet. 2002;359:892.
[Google Scholar]

[11] Keller E, Flacke S, Urbach H, Schild H. H., . Diffusion-and perfusion-weighted magnetic resonance imaging in deep cerebral venous thrombosis. Stroke. 1999;30:1144-6.
[Google Scholar]

[12] Smith A. G., Cornblath W. T., Deveikis J. P., . Local thrombolytic therapy in deep cerebral venous thrombosis. Neurology. 1997;48:1613-9.
[Google Scholar]

Reversible diencephalic dysfunction as presentation of deep cerebral venous thrombosis due to hyperhomocysteinemia and protein S deficiency: Documentation of a case

Abstract

ABSTRACT

Keywords

Deep cerebral venous thrombosis

headache

hyperhomocysteinemia

protein S deficiency

vasogenic edemae

Conflict of Interest

References

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