Cortical vein and transverse sinus thrombosis
Several day history of incoordination and altered mental status.
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History: 4-year-old with altered mental status.
Physical exam: Multiple bruises.
Labs: Heterozygous for factor V Leiden mutation.
Three lessons to be learned from this case:
- Cortical venous thrombosis can have a more dramatic effect on the brain than sinus thrombosis.
- When one venous thrombus is found, look for others.
- Factor V Leiden puts even a heterozygote at risk.
- Perez Botero J, Ormsby WD, Ashrani AA, McBane RD, Wysokinski WE, Patnaik MM, Lewis BR, Grill DE, Pruthi RK, Heit JA. Do incident and recurrent venous thromboembolism risks truly differ between heterozygous and homozygous Factor V Leiden carriers? A retrospective cohort study. European journal of internal medicine. 30: 77-81. doi:10.1016/j.ejim.2016.02.023 - Pubmed