Acute sinovenous thrombosis with multiple etiologic factors

Abstract

<p>In childhood; the incidence of intracranial thrombosis is 2.5-2.7/100000. They may present with different symptoms according to the location and size of the occluded vessel and age of the patient. In most cases; cranial imaging is necessary to confirm the lesion. Pediatric cerebrovascular thrombosis may be related to more than one etiologic factor so detailed evaluation is mandatory. A thirteen-year-old boy presented to our emergency room with a complaint of seizure. His cranial imaging showed thrombosis in left transversesigmoid sinuse. His father had been diagnosed to have deep venous thrombosis. In our case and in his father; protein S levels were found as 11.9% and 10.6% (N: %80-120) respectively and they were started on anticoagulation therapy. Our patient?s homocsyteine level was 15.5 mmol/lt (N: 0-12). His methylene- tetrahydrofolate reductase thermolabile enzyme (C677T) mutation was found homozygous. He was also started on oral folic acid therapy. A year after his first presentation, his protein S level was 16% and homocysteine level was 7.5 mmol/lt. His last cranial imaging showed no progresssion in the prior lesion and no new lesion.</p>

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<p>Akut ven?z sin?s trombozunda ?oklu etioloji</p>

<p>?ocukluk d?neminde intrakraniyal tromboz g?r?lme s?kl??? 2,5-2,7/100 000?dir. Semptomlar etkilenen damar?n boyutuna, intrakraniyal yerle?imine ve hastan?n ya??na g?re de?i?ir. Bir?ok fakt?r etiolojide rol oynayabilece?i i?in hastalar?n ayr?nt?l? tetkik edilmesi gerekir. Konv?lziyon nedeni ile acil servisimize ba?vuran on ?? ya??ndaki erkek olgunun kraniyal g?r?nt?lemesinde sol tranvers-sigmoid sin?ste tromboz saptand?. Babas?nda derin ven trombozu ?yk?s? olan olgumuzun protein S d?zeyi % 11,9 (%80-120) babas?nda ise protein S?i %10,6 saptanarak her ikisine de oral antikoag?lasyon tedavisine ba?land?. Ayn? zamanda homosistein d?zeyi 15,5 mmol/lt (0-12) bulunan hastam?zdan metil tetrahidrofolat red?ktaz enzim aktivitesi g?nderildi. Sonu? homozigot mutant olarak de?erlendirildi (C 6775) ve oral folik asit tedavisine ba?land?. Bir y?l sonra hastan?n protein S d?zeyi %16 ve homosistein d?zeyi 7,5 mmol/lt olarak saptand?. Kraniyal manyetik rezonans g?r?nt?lemesinde yeni bir tromboz olu?umu yoktu ve konv?lziyonu tekrarlamam??t?.</p>