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[Hyperhomocysteinemia-related cerebral venous thrombosis]
M C Fernández-Moreno1, L Castilla-Guerra, A Castella-Murillo
1Servicio de Neurología, Hospital Universitario Virgen de Valme, Sevilla, España. castillafernandez@hotmail.com
Insights
Moderate hyperhomocysteinemia is a risk factor for blood clots. This case report highlights a young woman with cerebral venous sinus thrombosis linked to high homocysteine levels, emphasizing the need for awareness and potential supplementation.
Area of Science:
- Neurology
- Hematology
- Cardiovascular Medicine
Background:
- Moderate hyperhomocysteinemia is a known risk factor for atherosclerosis and venous thromboembolism.
- Cerebral venous thrombosis (CVT) is a rare but serious condition.
- Few cases link hyperhomocysteinemia to CVT in medical literature.
Observation:
- A 21-year-old woman using oral contraceptives presented with headache, nausea, and vomiting.
- Clinical examination revealed papilledema.
- Imaging confirmed thrombosis of the left lateral sinus.
Findings:
- Hypercoagulability studies revealed persistently high homocysteine levels.
- Immunologic tests for autoimmune conditions were negative.
- The patient improved with anticoagulant therapy and management of brain edema.
Implications:
- Hypercoagulable states, including moderate hyperhomocysteinemia, are present in 70% of CVT patients.
- Homocysteine may induce endothelial dysfunction, contributing to venous thrombosis.
- Oral contraceptives can elevate venous thrombosis risk in prothrombotic states; folic acid and vitamin supplementation are discussed.
Introduction:
Moderate hyperhomocysteinemia is a causal risk factor for atherosclerosis and venous thromboembolism. Recent researches have tried to find out a causal relationship. However, only a small number of cases have been reported on hyperhomocysteinemia and cerebral venous thrombosis in the world medical literature.
Case Report:
We present the case of a 21 years old woman, and oral contraceptives taker, who consulted for a one week clinical picture of biparietal headache, nausea and vomiting. Examination revealed bilateral papilledema, and subsequent CT scan, MRI and MR angiography showed thrombosis of the left lateral sinus. Immunologic tests (antinuclear antibodies, antiphospholipid antibodies) were negative. Hypercoagulability studies showed persistent homocysteine high levels. The patient improved and was discharged after treatment with anticoagulants and therapeutic measures against brain edema.
Discussion:
The 70 percent of the patients with thrombosis of the cerebral venous sinuses present hypercoagulable states, including moderate hyperhomocysteinemia. Several mechanisms are proposed for venous thrombosis in hyperhomocysteinemia, homocysteine induced endothelial dysfunction between others. Otherwise, oral contraceptives can increase the risk of venous thrombosis in other prothrombotic conditions. Folic acid and vitamins supplementation therapy are commented.