Abstract
Cerebral venous thrombosis (CVT), a rare and life threatening complication of nephrotic syndrome, has a variable and non-specific presentation, posing diagnostic challenges. We describe a case of CVT in a Sierra Leonean child with nephrotic syndrome who was successfully treated for the condition despite the resource limitations of the hospital. This case highlights the importance of considering cerebral venous thrombosis as a complication of idiopathic nephrotic syndrome in children presenting with neurological symptoms.
Highlights
Nephrotic syndrome, which affects about 16 per 100,000 children annually [1], is characterised by a triad of proteinurea, oedema, and hypoalbumenaemia
Idiopathic nephrotic syndrome is subdivided histologically into three types-minimal change (MCNS), focal segmental glomerulorsclerosis, and membranoproliferative glomerulonephritis - with 70-80% of all cases being due to MCNS
Cerebral venous thrombosis is a rare complication of nephrotic syndrome and carries a considerable risk of cognitive impairment, sensorimotor and visual deficits, and epilepsy
Summary
Nephrotic syndrome, which affects about 16 per 100,000 children annually [1], is characterised by a triad of proteinurea, oedema, and hypoalbumenaemia. A 14-year old boy with no significant past medical history presented to a small district hospital in southern Sierra Leone with a 4 day history of facial puffiness, peripheral pitting oedema, abdominal pains, and reduced urine output. On examination he was afebrile, BP150/110, heart rate 70. The child was started on high dose subcutaneous unfractionated heparin daily This decision was made cautiously, but it was felt that the advantages surpassed the risks. On day 6 of admission his headache had improved and his focal neurological signs began to resolve He still had a partial right VI nerve palsy and a convergent squint. At 12 weeks follow-up, his urinalysis showed a trace proteinurea but he remained in remission
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