Thalamic stroke secondary to straight sinus thrombosis in a nephrotic child

Abstract

A 7-year-old Chinese boy with steroid-resistant nephrotic syndrome developed thalamic stroke secondary to straight sinus thrombosis. He was hospitalized due to status epilepticus and coma. The child recovered after treatment by low-molecular-weight heparin (LMWH) and warfarin. This case highlights the importance of magnetic resonance imaging with venography in the early diagnosis of cerebral sinus thrombosis (CST) in nephrotic children and the effectiveness of anticoagulation therapy in improving the neurological outcome.

Cerebral sinovenous thrombosis and idiopathic nephrotic syndrome in childhood: report of four new cases and review of the literature

“…However, in two of our Toronto patients, initial non-contrast CT scans were reported as being normal, and CSVT was diagnosed on subsequent contrast-enhanced imaging. Similarly, in the patient of Lin et al [28], the initial CT scan was normal and the diagnosis was made 5 days later with MRI, which stresses the importance of additional imaging studies when there is a high index of suspicion.…”

“…One child died secondary to massive pulmonary emboli, which developed subsequently [9] and an other had residual cognitive impairment probably in relation to a bilateral venous thalamic infarct. [28] None of the patients had recurrence of a thrombotic event.…”

Neurologic Presentations of Renal Diseases

“…34,35 Venous sinus thrombosis in pediatric patients with nephrotic syndrome present with headache, vomiting, coma, or seizures. 34,36 This usually occurs during relapse in steroid-resistant nephrotic syndrome due to hepatic coagulation inhibitors synthesis increase and abrupt urinary antithrombin loss. 34,36 Serum protein C and protein S levels were reported to be increased in steroid-resistant nephrotic children.…”

Cerebral sinovenous thrombosis in a nephrotic child

“…Thrombosis of various vessels has been reported, but CST associated with nephrotic syndrome appears to be very rare and only a few isolated reports exist in the literature [2][3][4][5][6][7][8][9][10][11][12][13] . Divekar et al reported only 1 case of CST out of 700 children with nephrotic syndrome followed over a period of 17 years 6 .…”

“…Arterial and venous thromboses are well-recognized classic complications of nephrotic syndrome, however these are far less frequent in children than in adults 1 Cerebral sinovenous thrombosis (CST) associated with nephrotic syndrome in children is extremely rare and only a few isolated reports exist in the literature [2][3][4][5][6][7][8][9][10][11][12][13] .…”