Sixth Cranial Nerve Palsy and Dense Cerebral Venous Sinus Thrombosis in a Child with Nephrotic Syndrome

Overview

Journal BMJ Case Rep

Specialty General Medicine

Date 2023 Jun 3

PMID 37270177

Authors

Sucheta Parija

Nikita Dash

Genickson Jeyaraj

Affiliations

Soon will be listed here.

Abstract

Nephrotic syndrome (NS) is a common glomerular disease characterised by massive proteinuria, hypoalbuminaemia, oedema and hyperlipidaemia. Cerebral venous sinus thrombosis (CVST) is a rare complication in children with NS. Here, we report a case of relapsing NS on steroid therapy, in a male in early childhood who presented with symptoms of headache, vomiting and double vision. On prism cover test there was 25 PD esotropia with abduction restriction in the left eye. Fundus examination showed bilateral papilloedema. He was diagnosed as sixth cranial nerve palsy of left eye. Neuroimaging reported dense CVST. He was managed with subcutaneous low molecular weight heparin and steroids. After 2 months of treatment, there was a complete resolution of esotropia and optic disc oedema. This case highlights the importance of early diagnosis of acute onset esotropia and sagittal sinus thrombosis in a case of NS.

References

Zaragoza-Casares P, Gomez-Fernandez T, Zato-Gomez de Liano M, Zaragoza-Garcia P . Superior sagittal sinus thrombosis and bilateral sixth-nerve palsy in a child with nephrotic syndrome. Pediatr Nephrol. 2007; 22(5):753-5. DOI: 10.1007/s00467-006-0419-5. View

He J, Yang F . Cerebral Venous Sinus Thrombosis in a Child With Idiopathic Nephrotic Syndrome: A Case Report and Review of the Literature. Cureus. 2020; 12(10):e11248. PMC: 7707130. DOI: 10.7759/cureus.11248. View

Orth S, Ritz E . The nephrotic syndrome. N Engl J Med. 1998; 338(17):1202-11. DOI: 10.1056/NEJM199804233381707. View

Torres R, Torres B, de Castilho A, Honorato R . Venous sinus thrombosis in a child with nephrotic syndrome: a case report and literature review. Rev Bras Ter Intensiva. 2015; 26(4):430-4. PMC: 4304474. DOI: 10.5935/0103-507X.20140066. View

Al Fakeeh K, Al Rasheed S . Cerebral venous thrombosis in the nephrotic syndrome. Saudi J Kidney Dis Transpl. 2008; 11(1):59-63. View

Bhoobun S, Jalloh A, Jacobsen K . Cerebral venous thrombosis in a child with nephrotic syndrome: case report. Pan Afr Med J. 2013; 13:57. PMC: 3549447. DOI: 10.11604/pamj.2012.13.57.1954. View

Ghedira Besbes L, Haddad S, Gabsi A, Hassine M, Ben Meriem C, Guediche M . Cerebral sinovenous thrombosis in a child with idiopathic nephrotic syndrome. Case Rep Nephrol. 2014; 2011:724950. PMC: 3914126. DOI: 10.1155/2011/724950. View

Mittal S, Siddiqui J, Katirji B . Abducens nerve palsy due to inferior petrosal sinus thrombosis. J Clin Neurosci. 2017; 40:69-71. DOI: 10.1016/j.jocn.2017.02.018. View

Gangakhedkar A, Wong W, Pitcher L . Cerebral thrombosis in childhood nephrosis. J Paediatr Child Health. 2005; 41(4):221-4. DOI: 10.1111/j.1440-1754.2005.00592.x. View

10.

Gaur N, Sharma P, Takkar B, Singh J . Acute-onset diplopia in a case of nephrotic syndrome. BMJ Case Rep. 2017; 2017. PMC: 5665272. DOI: 10.1136/bcr-2017-221475. View

11.

Lee J, Murray K, Renati S . A Case Report of Extensive Cerebral Venous Sinus Thrombosis as a Presenting Sign of Relapsing Nephrotic Syndrome. Case Rep Neurol Med. 2020; 2019:6840240. PMC: 6948327. DOI: 10.1155/2019/6840240. View

12.

Park S, Shin J . Complications of nephrotic syndrome. Korean J Pediatr. 2011; 54(8):322-8. PMC: 3212701. DOI: 10.3345/kjp.2011.54.8.322. View

13.

Rodrigues M, Zardini L, Andrade M, Mangia C, Carvalhaes J, Vilanova L . Cerebral sinovenous thrombosis in a nephrotic child. Arq Neuropsiquiatr. 2004; 61(4):1026-9. DOI: 10.1590/s0004-282x2003000600027. View

14.

Einhaupl K, Stam J, Bousser M, de Bruijn S, Ferro J, Martinelli I . EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010; 17(10):1229-35. DOI: 10.1111/j.1468-1331.2010.03011.x. View

15.

Ghoneim A, Straiton J, Pollard C, MacDonald K, Jampana R . Imaging of cerebral venous thrombosis. Clin Radiol. 2020; 75(4):254-264. DOI: 10.1016/j.crad.2019.12.009. View

16.

Kuehnen J, Schwartz A, Neff W, Hennerici M . Cranial nerve syndrome in thrombosis of the transverse/sigmoid sinuses. Brain. 1998; 121 ( Pt 2):381-8. DOI: 10.1093/brain/121.2.381. View

17.

Isik Balci Y, Tavil B, Fidan G, Ozaltin F . Cerebral sinovenous thrombosis in a child with steroid sensitive nephrotic syndrome. Eur J Pediatr. 2007; 166(7):757-8. DOI: 10.1007/s00431-007-0488-x. View

18.

Silva A, Tavares J, Vaz A, Brito N, Vasconcelos M, Sevivas T . Cerebral Venous Sinus Thrombosis in a Child with Idiopathic Nephrotic Syndrome: a case report. J Bras Nefrol. 2018; 40(4):418-422. PMC: 6534000. DOI: 10.1590/2175-8239-jbn-2018-0009. View

19.

Gera D, Yadav D, Kute V, Patil S, Trivedi H . Cerebral venous sinus thrombosis in children with nephrotic syndrome. Indian J Nephrol. 2013; 22(6):455-8. PMC: 3573488. DOI: 10.4103/0971-4065.106042. View