Cerebral Venous Sinus Thrombosis as an Initial Presentation of Nephrotic Syndrome: A Case Report

Abstract

Yassir Balla,1 Abdullahi Said Hashi,2 Ahmed Adam Osman,3,4 Mohamed Sheikh Hassan,5 Eren Mutlu3 1Department of Internal Medicine, Somali-Sudanese Specialized hospital, Mogadishu, Somalia; 2Department of Anesthesiology and Reanimation, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 3Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia; 4Faculty of Medicine and Surgery, University of Somalia, Mogadishu, Somalia; 5Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Ahmed Adam Osman, Department of Radiology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia, Email [email protected]: Cerebral sinovenous thrombosis (CSVT) encompasses a spectrum of disorders involving thrombosis of the cerebral venous system. As shown by previous epidemiological studies, the prevalence of cerebral sinovenous thrombosis is 4– 7 cases per million people. Nephrotic syndrome was very rarely associated with thrombosis cerebral veins or sinuses. Hypercoagulability and thrombotic complications in nephrotic syndrome are most commonly seen in deep veins of the lower extremities and renal veins. Our case highlights a unique scenario in which cerebral sinovenous thrombosis was the initial presentation of nephrotic syndrome in a patient that was not an important past medical or surgical problem. The patient was brought to the emergency department with severe headache, vomiting, altered mental status, and generalized body swelling. Laboratory results showed proteinuria, hypoalbuminemia and hyperlipidemia. Non-contrast brain CT demonstrated hemorrhagic venous infarct associated with vasogenic edema. A subsequent brain MR venogram demonstrated occlusion of superior sagittal and right transverse sinuses. She was managed with low molecular weight heparin and intervenous corticosteroids then shifted to rivaroxaban and oral steroids, respectively, which resulted in massive clinical improvement and resolution of thrombus.Keywords: nephrotic syndrome, cerebral venous sinus thrombosis, MR venography

Keywords

• nephrotic syndrome
• cerebral venous sinus thrombosis
• mr venography