Abstract:

Objective To get a better understanding and to explore a proper criteria for early diagnosis and treatment of nephrotic syndrome(NS)with cerebral venous thrombosis (CVT) in children from clinical analysis. Methods From Jan. 2012 to Sep. 2015, data of children of NS with CVT who had been diagnosed by brain CT scan and head MRI in Shanghai Children's Hospital were enrolled. Clinical symptom features, laboratory data and radiographs findings, treatment effect and prognosis of all cases were collected and analyzed.Results Four cases of NS patients with CVT were included in the analysis. Four cases were all male. The age range was from 5 years 4 months to 11 years 4 months. When they had CVT, the onset of NS was 1 months to 7 years later. Clinical manifestations of all patients were different, and they were mainly manifested as neurological symptoms. And they all had no positive signs of nervous system. D-dimer and FDP of 3 cases abnormally elevated significantly, and AT-Ⅲ dropped. After these children had been diagnosed, D-dimer and FDP increased further. Serum albumin levels of 4 cases obviously decreased, and total cholesterol obviously increased. The patients with clinical symptoms were requested to do head enhanced MRI+ MRV+MRA on the same day or the second day, and 3 cases were confirmed with the left sigmoid sinus thrombosis, 1 case was cerebral embolism. 3cases were treated immediately with urokinase thrombolysis, low molecular weight heparin calcium and dipyridamole anticoagulant after confirmed diagnosis. One child with cerebral embolism had symptomatic treatment and anticoagulation therapy. Patient's symptoms were rapidly relieved. Follow-up with head enhanced MRI+ MRV of 3 cases showed that intracranial abnormal signals had been absorbed with different degree.Conclusion NS with CVT in children was easy to occur in the left sigmoid sinus thrombosis. When suspected abnormal nervous-mental system symptom appeared during NS course, timely head MRI related examination may be helpful to make early diagnosis of CVT. Prompt thrombolysis therapy had a favourable prognosis.