Association of two prothrombotic conditions in a 16-year-old boy with cerebral venous sinus thrombosis and newly diagnosed type 1 diabetes: case report

Cerebral venous sinus thrombosis is a disease that mainly affects young people, with a peak age of 39 years. It is rare in children and most often occurs in the neonatal period.The patient, a 16-year-old boy, without any chronical diseases, went to family doctor with complaints of headaches that have been around for 1 year, but have lately worsened after drinking alcohol 2 weeks ago. The pain tending to be both bilateral and unilateral, starting in the temples and moving to one eye. Blood tests were performed, which showed an elevated glucose level of 27.32 mmol/l. The patient was urgently hospitalized. In hospital diabetic therapy and rehydration was started. CT scan of the head is performed, where no pathological changes are detected. Against the background of the received therapy, the headache persists. The patient was consulted by a pediatric neurologist and was prescribed an MR head with angiography. MR conclusion - sinus sagitalis superior, right sinus transversus, sinus sigmoideus thrombosis. No data are available on venous ischaemia. Low molecular weight heparin therapy has been initiated. Genetic analyzes were performed, which found a mutation in factor V (Leiden factor), resistance to activated protein C, and elevated homocysteine levels. The patient's headache decreased after treatment. Due to the risk of thrombosis, long-term treatment with warfarin for INR 2-3 has been initiated. Although cerebral venous thrombosis is a rare cause of headache in adolescence, it should be considered as one of the options for differential diagnosis, also taking into account the associated conditions.