Cerebral venous sinus thrombosis in children with nephrotic syndrome
A 3 and a 1/2-year-old boy weighing 12.5 kg with new onset nephrotic syndrome of 15 days duration presented with continuous frontal headache for 3 days at the time of admission. Headache was not associated with fever, vomiting, and blurring of vision. He was taking prednisolone 15 mg/d for nephrotic syndrome. Past medical history and family history was unremarkable. On admission, patient was conscious, cooperative, and well oriented. His pulse rate was 86/min and blood pressure was 100/60 mmHg. On general examination, child showed moderate ascitis and peripheral edema. Rest of systemic examination was normal.\nInvestigations showed hemoglobin 11.6 gm/dl, total leucocyte count of 11800/mm3, platelet 2.3 lac/mm3, serum creatinine of 0.50 mg/dl, blood urea of 22 mg/dl, and serum albumin of 1.7 gm/dl, S. Serum cholesterol was 537 mg/dl. Serum electrolytes were normal. Renal ultrasound revealed normal sized kidney. Coagulation profile showed prothrombin time of 10 s with INR of 1.1, and activated partial thromboplastin time of 29 s Cranial MRI and MRV showed thrombosis of superior sagittal, bilateral transverse and bilateral sigmoid sinuses [].\nHis steroid dose was continued at 15 mg per day and daily intravenous human albumin (20%) 50 ml was given for 5 days till his serum albumin rose to 3 gm/dl. He was started on deltaparin (LMWH) 1000 U (75-100 U/kg each dose 12 h) subcutaneous twice daily for 5 days and warfarin was added on the fourth day with a dose of 0.75 mg (in dose range of 0.05-0.1 mg/kg) twice a day. Sixth day onwards, patient was maintained on warfarin only to keep INR between 2.0 and 2.5. There was complete resolution of headache within 5 days of starting the treatment. His MRI with MRV done 3 weeks later showed significant dissolution of thrombosis in all affected sinuses. Presently, the boy is on warfarin 1.5 mg for venous thrombosis, prednisolone 15 mg/day, and mycophenolate mofetyl 125 mg twice a day with his nephrotic state in remission. MRV after 3 weeks of treatment is shown in .