Intracranial hypertension due to saggital vein thrombosis in a patient with nephrotic syndrome

Abstract

Between the possible complications observed in nephrotic syndrome, arterial and venous thrombotic phenomena, including cerebral venous thrombosis, must be considered. 

Objective: We report the clinical evolution of a child who developed a superior longitudinal sinus thrombosis. 32 similar cases were found in the literature with which we compared our patient. 

Clinical case: 14 year male admitted with symptomatic nephrotic syndrome, mild cephalea and bilateral papilloedema. Cerebral CT and angio-MRI showed an acute phase superior longitudinal sinus thrombosis. The most significany finding was an increased intracranial pressure of 44cm of water. The progressive increase of anticardiolipin antibodies was the determinant factor in inciating long term anticoagulation. 

Conclusions: In nephrotic syndrome the presence of a hypercoagulable state, along with dyshydration or minimal trauma can provoke thrombosis in different vessels including the cerebral sinuses. The most frequently affected is the superior longitudinal sinus. Symptoms can be subtle even with significant intracranial hypertension, the reason why this condition can be underdiagnosed if not suspected.