HYPERHOMOCYSTEINEMIA AND CORTICAL VENOUS THROMBOSISA CASE REPORT
Abstract
Cortical venous thrombosis is often a
missed diagnosis unless you look for it. It
is due to occlusion of cortical veins draining
the brain. It constitutes 0.5 of all
strokes. The aetiology of CVT is vast and
can be classified into infectious, noninfectious
causes. Unless actively intervened,
its devastating due to increased
intracranial tension. We discuss here, a
case of cortical venous thrombosis with
hyperhomocysteinemia. We evaluated
for other causes but results are inconclusive
of any other aetiology. Hyperhomocysteinemia
has been associated with
CVT. Severe headache is the usual presenting
complaints, followed by seizures
and altered sensorium. CT brain can
demonstrate classical delta sign. MRI
with T1, T2, fluid-attenuated inversion
recovery and T2 (echo planar) sequences
with Magnetic resonance angiography
will pick up the extent of lesion
and useful in diagnosing and treating the
patients. Regarding management there
are various controversies for fibrinolysis,
anticoagulation, mechanical fibrinolectomy
and surgery.
But, still anti-coagulation withheparin remains
primary treatment in managing acute
cases.
Full Text:
PDFReferences
Penix LP . Ischemic strokes secondary
to vitamin B12 deficiency-induced
hyperhomocystinemia. Neurology
; 51(2): 622-4den Heijer M, Blom
HJ, Gerrits WBJ, Rosendaal FR, Haak
HL, Wijermans
PW. Is hyperhomocysteinaemia a risk factor
for recurrent venous thrombosis? Lancet
; 345:882-885
S.Cakmak; L. Derex; M. Berruyer; N.
Nighoghossian, F. Philippeau, P. Adelenie,
M.Hermier, J.C. Forment,P. Trouillas.
Cerebral venous thrombosis: clinical outcome
and systematic screening ofprothrombotic
factors. Neurology 2003;
:1175-1178
Goodnight SH Jr., Hathaway WE. Disorders
of Hemostasis & Thrombosis, 2nd
ed.NewYork: McGrawHill, 2001 pp.397-
den Heijer M, Koster T, Blom HJ, Bos
GMJ, Briët E, Reitsma PH, VandenbrouckeJP,
Rosendaal FR. Hyperhomocystinemia
as a risk factor for deep vein
thrombosis. NEngl J Med. 1996; 334:759-
Simioni P, Prandoni P, Burlina A, Tormene
D, Sardella C, Ferrari V, Benedetti
L,Girolami A. Hyperhomocystinemia and
deep vein thrombosis.Thromb Haemost.
; 76:883-886
Brattström L, Tengborn L, Lagerstedt
C, Israelsson B, Hultberg B. Plasmahomocysteine
in venous thromboembolism.
Haemostasis 1991; 21:51-57
Amundsen T, Ueland PM, Waage A.
Plasma homocysteine levels in patients
withdeep venous thrombosis. Arterioscler
Thromb Vasc Biol.1995;15:1321-1323
Cantu C, Alonso E, Jara A, et al. Hyperhomocysteinemia,
low folate and vitamin
B12 concentrations, and methylene tetrahydrofolate
reductase mutation in cerebral
venous thrombosis. Stroke 2004; 35:
–98
Martinelli I, Battaglioli T, Pedotti P,
Cattaneo M, Mannucci PM. Hyperhomocysteinemia
in cerebral vein
thrombosis. Blood 2003; 102: 1363–66.
Ventura P, Cobelli M, Marietta M,
Panini R, Rosa MC, 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:
–59.
Dentali F, Crowther M, Ageno W.
Thrombophilic abnormalities, oral
contraceptives, and risk of cerebral
vein thrombosis: a meta-analysis.
Blood. 2006;107:2766 –2773.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
An initiative of The Tamil Nadu Dr M.G.R. Medical University