Cerebral Sinovenous Thrombosis Related to Iron Deficiency Anemia As a Result of Severe Menorrhagia: A Case Report

Abstract 5143

Cerebral sinovenous thrombosis (CSVT) is a rare condition with a wide spectrum of non-specific symptoms, which makes it occasionally difficult to diagnose. CSVT has been associated with various etiologies including dehydration, hypercoagulable states, neoplasmic invasion of a venous sinus, intracranial and systemic infections, use of oral contraceptives, puerperium and pregnancy. Although iron deficiency anemia (IDA) has been reported as a cause of CSVT in several pediatric cases, this association is extremely rare. To our knowledge, IDA-associated CSVT in teenagers has been rarely reported.

Here, we present the case of a 13-year old female with complete thrombosis of the vein of Galen, the straight sinus, and the left internal cerebral vein related to iron deficiency anemia as a result of severe menorrhagia. She initially presented with three-week history of headaches, nausea and vomiting. She was initially diagnosed and treated for bacterial sinusitis by her primary pediatrician, without symptom relief. She then suffered a syncopal episode, reason why she was evaluated at our institution. Initial laboratories revealed a slightly increased PT (15. 6 secs), hemoglobin of 5. 1 g/dL, MCV 63. 6 and D-dimer 1. 31. Non-contrast brain CT demonstrated no evidence of stroke, hemorrhage or mass. However, an abnormal hyperdensity in the straight sinus, inferior sagittal sinus, vein of Galen, and deep cerebral veins, were suggestive of venous thrombosis. Findings were then confirmed by brain MRI/MRV/MRA and CT angiogram. A bleeding work-up performed based on her history of heavy menses was normal. Her ferritin level was significantly decreased (6 ng/mL). Iron supplementation was initiated as well as progestin-only hormonal therapy for menstrual cycle regulation. The patient's clinical status improved back to baseline during her 8-day admission. She was discharged home on anticoagulation with scheduled follow up. Brain MRI/MRV six months later showed patency of the cerebral veins and dural venous sinuses.

IDA should be considered as an underlying cause of CSVT in pediatric patients, particularly in patients with other risk factors for thrombosis including dehydration, regardless of their age. Early recognition and management of CSVT is critical to minimize the possibility of permanent neurologic damage. Physicians should be aware of the non-specific signs and symptoms of CSVT and should have a high index of suspicion in patients with anemia.