Thrombophilic Evaluation in Cases of Cerebral Venous Sinus Thrombosis

Abstract

We read with interest the article entitled ‘Cerebral Venous Sinus Thrombosis in a Patient with Meningococcal Meningitis’, published in the January 2018 issue of the Oman Medical Journal. Bacterial meningitis is a life-threatening condition, and Neisseria meningitidis is a major cause. Cerebrovascular complications can occur. Cerebral venous sinus thrombosis (CVST) is a rare type of these complications, especially in meningococcal meningitis. According to Virchow’s classification, causes of CVST can be categorized into three main groups according to hypercoagulation state, blood flow disturbances, and infection or inflammation. Also, multiple risk factors can be found in patients with CVST. Hence, a thorough study of other causes should be done even if a specific risk factor is identified. In the presence of some prothrombotic conditions, the risk of CVST increases when exposed to infection. For example, a case of CVST complicating meningococcal meningitis has been reported. Thrombophilic study revealed hyperhomocysteinemia and methylenetetrahydrofolate reductase variants (C677T and A1298C). The authors’ opinion was that this predisposing thrombophilic condition to CVST might be triggered by a central nervous system infection such as meningitis. Hence, thrombophilic evaluation in patients diagnosed with CVST seems necessary although, in the reported case, meningococcal meningitis was the most probable cause for CVST. The authors did not mention performing any thrombophilic evaluation, which seemed necessary in their patient.

Keywords