Abstract
IntroductionCerebral venous thrombosis is relatively rare and characterized by a wide spectrum of clinical features. It is more common in young adults with women affected more than men. The diagnosis of cerebral venous thrombosis is easier nowadays due to easy access to advanced neuroimaging techniques. Abnormalities in thrombophilic profile are associated with enhanced risk of cerebral venous thrombosis. It has varied etiologies such as hypercoagulable states, infection, dehydration, pregnancy, and substance abuse. Hyperhomocysteinemia is found to be closely associated with an enhanced risk of cerebral venous thrombosis.Case presentationHere we report a case of cerebral venous thrombosis secondary to hyperhomocysteinemia caused by vitamin B12 deficiency in a 32-year-old Indo-Aryan man. A detailed coagulation workup led us to find the etiology of cerebral venous thrombosis in this patient who followed a strict vegetarian diet and had vitamin B12 deficiency leading to hyperhomocysteinemia.ConclusionThere are conflicting reports in the literature about the association of hyperhomocysteinemia, B12 deficiency, and cerebral venous thrombosis but some reports point to a significant association. We conclude that further studies with a large sample size are required to analyze the effect of hyperhomocysteinemia and low vitamin B12 on the risk of cerebral venous thrombosis.
Highlights
IntroductionCerebral venous thrombosis represents 0.5–3% of all cases of stroke affecting mainly the younger population with an incidence of 3–4 per million in adults [1]
Cerebral venous thrombosis is relatively rare and characterized by a wide spectrum of clinical features
It is a severe thrombotic manifestation resulting in marked disability and has a tendency to recur. It has varied etiologies such as hypercoagulable states, infection, dehydration, pregnancy, drugs such as oral contraceptive pills and substance abuse. This case report highlights the importance of hyperhomocysteinemia (Hhcy) secondary to vitamin B12 deficiency leading to cerebral venous thrombosis
Summary
Cerebral venous thrombosis represents 0.5–3% of all cases of stroke affecting mainly the younger population with an incidence of 3–4 per million in adults [1]. Case presentation A 32-year-old Indo-Aryan man presented to our emergency department with history of frequent vomiting, moderate to severe headache and giddiness for past 5 days He developed weakness of the right side of his body along with altered sensorium over last 24 hours prior to presentation. Peripheral blood film showed macrocytes and macro-ovalocytes with hypersegmented neutrophils He had low serum cobalamin levels 68 pg/ml (200–600) with normal folate levels. A diagnosis of cerebral venous thrombosis due to Hhcy secondary to cobalamin deficiency was made He was treated with sodium valproate 20 mg/kg administered intravenously followed by orally administered valproate 20 mg/kg in two divided doses which was gradually escalated on follow-up visits.
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