A Case of Cerebral Venous Thrombosis Associated with Minimal Change Nephrotic Syndrome

ABSTRACT

Nephrotic syndrome causes a hypercoagulable state, leading to both venous and arterial thrombosis. Thromboembolic events occur frequently in patients with nephrotic syndrome. However, central venous thrombosis occurs less frequently as a complication of minimal change nephrotic syndrome. The pathogenic mechanisms are not yet unclear, but various alterations in coagulant and anti-coagulant factors may be responsible. We report a case of cerebral venous thrombosis associated with minimal change nephrotic syndrome. A 27-year-old man was admitted due to sudden, severe headache with nausea and vomiting. He complained of a continuous throbbing-type headache in bifrontal area. One month prior to the symptoms, he was diagnosed as having nephrotic syndrome based on clinical manifestations and biopsy findings. The routine laboratory findings showed that he had hyperlipidemia, hypoalbuminemia and proteinuria. In clotting factor analysis, fibrinogen, factor VII, VIII and von Willebrand factor were increased and factor XII, antithrombin III and protein S were decreased. The unenhanced brain CT scan showed a triangle-shape high density in a superior sagittal sinus and gadolinium enhanced brain MRI showed unenhanced blood clot in a superior sagittal sinus. Initial brain MR venography showed a lack of filling of a superior sagittal sinus and poor visualization of cortical veins.