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Cerebral Venous Sinus Thrombosis Secondary to Vitamin B12 Deficiency - A Case Series with Emphasis on Food
Neena Baby1, Minu George1, Arjun Rajasekharan2
1Department of Neurology, Renai Medicity Multi Super Speciality Hospital, Kochi, Kerala, India.
Insights
Hyperhomocysteinemia (hHcy), a condition of high homocysteine levels, is linked to cerebral venous sinus thrombosis (CVST). Supplementing with B vitamins, especially B12, can help manage this condition, particularly in vegetarian populations.
Area of Science:
- Neurology
- Hematology
- Nutritional Science
Background:
- Cerebral venous sinus thrombosis (CVST) has diverse causes, with hyperhomocysteinemia (hHcy) identified as an independent risk factor.
- Understanding the role of metabolic factors like hHcy is crucial for managing CVST.
Observation:
- Three cases of CVST are presented, all initially manifesting with headache.
- Two patients exhibited papilledema and visual disturbances, indicative of increased intracranial pressure.
- Diagnostic workup confirmed CVST and revealed hyperhomocysteinemia in all cases, with two also showing very low Vitamin B12 levels.
Findings:
- Treatment involved low-molecular-weight heparin, followed by oral anticoagulation and supplementation with Vitamins B6, B9, and B12.
- All patients responded positively to the therapeutic regimen.
- Follow-up imaging demonstrated resolution of thrombosis in two of the three patients.
Implications:
- Hyperhomocysteinemia should be considered in the etiological evaluation of CVST, particularly in individuals with a predominantly vegetarian diet.
- Dietary fortification with Vitamin B12 may be a beneficial preventive or therapeutic strategy, especially in populations with high vegetarian intake, such as in India.
Abstract:
The etiology of cerebral venous sinus thrombosis (CVST) is multifactorial. Although many acquired and genetic factors have been recognized as risk factors, hyperhomocysteinemia (hHcy) is independently associated with CVST. We describe three cases of CVST in this case series. All of them presented with headache. Two patients had papilledema and visual disturbances. On evaluation, there was CVST, and prothrombotic workup showed hHcy. In addition, two of them reported very low Vitamin B12 levels. All of them were treated with low-molecular-weight heparin followed by oral anticoagulation and Vitamin B6, B9, and B12 supplements. All of them responded to treatment, and follow-up imaging studies in two of them showed resolution of thrombosis. hHcy should be considered in the evaluation of CVST, especially in the setting of a pure vegetarian diet. Fortification of the diet with Vitamin B12 may be considered the majority of Indians consume predominantly vegetarian food.
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