Venous Stroke and Status Epilepticus Due to Milk-Induced Anemia in a Child

Abstract

The risk factors for cerebral sinus venous thrombosis include dehydration, infection, and anemia. The clinical presentation in children of venous strokes associated with cerebral venous thrombosis is variable and may include seizures. Acute management should focus on the treatment of the primary cause and anticoagulation or antiplatelet therapy if needed. Early recognition and targeted treatment is important because survivors are at increased risk for long-term neurologic complications. We report a case of a 4-year-old girl who presented with status epilepticus and was subsequently found to have a cerebral venous sinus thrombosis in the transverse and sigmoid sinus, with venous infarction in the temporal lobe. Laboratory results were significant for a microcytic anemia caused by excessive milk intake. Although iron deficiency anemia is a common pediatric disorder, this uncommon presentation demonstrates the potential for neurologic complications secondary to anemia, as well as the need for a high index of suspicion in order to identify venous stroke as a cause in children who present to the emergency department with seizures.

Severe anaemia and altered mental status in the young paediatric patient

“…Repeat MRI during the months of recovery helps to determine recanalization extent and thus the length of anticoagulation therapy, 1 as was the case with our patient. Treatment of the severe iron deficiency anaemia with supplemental iron and diet optimization is also necessary to minimise neurologic effects and the risk of recurrent cerebral venous sinus thrombosis 3,5,8 …”

“…5 However, presentations vary, and patients can present with one or multiple symptoms including: fevers, headaches, emesis, abdominal pain, upper respiratory symptoms, reduced feeding, irritability, lethargy, hemiparesis, hemiplegia and seizures. 2,[4][5][6] Definitive diagnosis is by head CT or MRI, with greatest sensitivity offered by MRI with MRV. If a non-contrast CT is negative in the setting of a clinical presentation that is strongly consistent with cerebral venous sinus thrombosis, CT venography with contrast or MRI must be obtained.…”

Too Much of a Good Thing? Cerebral Sinovenous Thrombosis Due to Excessive Milk Intake Associated Anemia

“…[29][30][31][32] There have also been several publications that establish the association of excessive milk intake as the etiology for iron-deficiency anemia and thus cerebral sinovenous thrombosis. 21,22,[31][32][33] Children, especially young children, with cerebral sinovenous thrombosis often present with vague symptoms. Typical symptoms may include headache, vomiting, lethargy, sixth cranial nerve palsy, and seizures.…”

“…One of the thrombotic diseases that can occur in young children is cerebral sinovenous thrombosis and can occur in the setting of iron-deficiency anemia. [20][21][22] Cerebral sinovenous thrombosis is potentially life threatening and can be associated with long-term neurologic sequelae. Iron-deficiency anemia is a preventable cause of cerebral sinovenous thrombosis in young children.…”

Eisenmangel, Thrombozytose und Thromboembolie

“…Eine ursprünglich vermutete direkte Wirkung über den Thrombopoetinrezeptor c-mpl [39] konnte nicht nachgewiesen werden [37,40]. Der EPO Spiegel korreliert schlecht mit der Plättchenanzahl und kann auch in der Abwesenheit einer Thrombozytose erhöht sein [32,37,40] [128] 2α und VEGF (vascular endothelial growth factor)-A mediiert sein [42]. Weiters ist die klinische Bedeutung der reaktiven Thrombozytose unklar.…”