Sourab Arora* Pradeep Tiwari and Varun Shetty

Department of General Medicine, DY Patil Hospital, Navi Mumbai, India

*Corresponding Author: Sourab Arora, Department of General Medicine, DY Patil Hospital, Navi Mumbai, India.

Received: August 21, 2024; Published: October 18, 2024

Abstract

Cerebral venous sinus thrombosis (CVST) is a rare and potentially life-threatening condition that can result from various underlying etiologies, including metabolic disorders like homocystinuria and local infections such as mastoiditis. We report a case of an 8-year-old female with a background of homocystinuria who presented with CVST secondary to right-sided mastoiditis. On 2D echocardiography, she was found to have a clot in the left atrial appendage, along with concentric left ventricular hypertrophy.

The patient, Abida Ansari, presented with a Acta Scientific Neurology cute onset of headache, vomiting, and fever. She had a history of subluxation of the lens due to decreased vision, managed surgically with pseudophakia in the right eye. On examination, the patient exhibited drowsiness, neck rigidity, and positive Brudzinski and Kernig signs. A fundoscopic examination revealed disc edema in the left eye. MRI showed loss of normal flow void in the superior sagittal sinus, right transverse sinus, and right sigmoid sinus, consistent with CVST, alongside evidence of right-sided mastoiditis and mild leptomeningeal enhancement in the right parieto-occipital lobe.

The patient’s homocysteine levels were markedly elevated (>50 µmol/L), indicating underlying homocystinuria as a contributing factor. Treatment included broad-spectrum antibiotics, dexamethasone, levetiracetam, anticoagulation with enoxaparin, and supportive measures.

This case highlights the complex interplay between metabolic and infectious causes of CVST, emphasizing the importance of early diagnosis and intervention. Elevated homocysteine levels due to homocystinuria, coupled with the presence of a left atrial appendage clot and concentric left ventricular hypertrophy, further underscore the need for vigilance in managing thrombophilic states in such patients.

 Keywords: Cerebral Venous Sinus Thrombosis, Homocystinuria, Mastoiditis, Pediatric Thrombosis, Hyperhomocysteinemia

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Citation

Citation: Sourab Arora., et al. “Cavernous Venous Sinus Thrombosis Secondary to Homocystinuria and Right Mastoiditis: A Case Report”. Acta Scientific Neurology 7.11 (2024): 10-13.

Copyright

Copyright: © 2024 Sourab Arora., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.