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Cerebral venous thrombosis is rare and often under diagnosed in children with nephrotic syndrome. MRI with venography is an essential tool in its diagnosis. Both early diagnosis and the commencement of anticoagulation are paramount for a good outcome. An 8 year old boy diagnosed with steroid dependent nephrotic syndrome with 12 relapses in the 2 years since diagnosis, presents and is admitted for another relapse following an intercurrent illness. Symptoms and signs at the time of admission are lethargy, cough, vomiting, abdominal pain, headache, generalised oedema and ascites. He is treated with high dose steroids and goes into remission within the next 3 days. However, he continues to complain of a headache not improved with analgesia. Magnetic Resonance Imaging (MRI) followed by venography are performed and the diagnosis of a dural sinus thrombosis is made. Initial neurology is intact, however, he develops signs of raised intracranial pressure and requires transfer to a tertiary centre. He is successfully treated with anticoagulants and a therapeutic lumbar puncture. The child is kept on anticoagulants and statins and is kept under follow up. Cerebral infarction is therefore avoided. Image 1 Image 2 Image 3 This case illustrates the importance of the consideration of prothrombotic tendency in children with nephrotic syndrome and what the consequences of this can be. It also highlights an important lesson for all those who look after these children in being vigilant in considering all complications and therefore ensuring they are managed appropriately and successfully within a multidisciplinary team.

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