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Logo of neurologyNeurologyAmerican Academy of Neurology
 
Neurology. 2008 August 12; 71(7): e12–e13.
PMCID: PMC2676983

Teaching NeuroImage: MRI visualization of papilledema associated with cerebral sinovenous thrombosis in a child

Section Editor: Section Editor Mitchell S.V. Elkind, MD, MS

A 3-year-old boy with ulcerative colitis and developmental delay presented with a 3-week history of headaches, emesis, and dehydration. His neurologic examination was nonfocal, but MR venogram revealed cerebral sinovenous thrombosis (figure). He was rehydrated and discharged on enoxaparin. Three months later he starting having difficulty reaching for objects and was running into walls. Repeat MRI and MR venogram demonstrated residual thrombosis and interval development of papilledema (figure). Papilledema was confirmed on funduscopic examination. CSF opening pressure was 37 cm H2O. When treatment with acetazolamide failed to control intracranial hypertension, he received a ventriculoperitoneal shunt.

figure znl0310857210001
Figure MRI

Inflammatory bowel disease (IBD) is a risk factor for venous thromboembolism.1 Attempts to identify a unifying genetic risk factor for thromboembolism in patients with IBD have yielded conflicting results. Endothelial damage from IBD, leading to platelet activation and release of inflammatory mediators by platelets, may play a role.2 Our patient’s prothrombotic workup demonstrated only heterozygosity for both the methylene tetrahydrofolate reductase (MTHFR) C677T and plasminogen activator inhibitor (PAI)-1 4G (also known as SERPINE 1) mutations.

ACKNOWLEDGMENT

The authors thank Dr. Michelle Nwosu for technical assistance.

Notes

Address correspondence and reprint requests to Dr. Meredith Golomb, Indiana University School of Medicine, 575 West Dr. XE-040, Indianapolis, IN 46202 ude.iupui@bmologm

Dr. Golomb is supported by the following grants: NIH NINDS K23 NS 048024 and Clarian Values Fund grant VFR-171.

Disclosure: The authors report no disclosures.

REFERENCES

1. Miehsler W, Reinisch W, Valic E, et al. Is inflammatory bowel disease an independent and disease specific risk factor for thromboembolism? Gut 2004;53:542–8. [PMC free article] [PubMed]
2. Standridge S, de los Reyes E. Inflammatory bowel disease and cerebrovascular arterial and venous thromboembolic events in 4 pediatric patients: a case series and review of the literature. J Child Neurol 2008;23:59–66. [PubMed]

Articles from Neurology are provided here courtesy of American Academy of Neurology