An uncommon presentation of hyperhomocysteinemia and vitamin B₁₂ deficiency: a case report

Cerebral 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.

Here 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.

There 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.