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CASE REPORTalong with the right sided sinuseswhere completely thrombosed.Anticoagulation with heparinfollowed by oral anticoagulation isthe treatment of choice for CVST[13,19,25,36]. Most of the studieshave shown good results with this[5,12,14,15,20,21,25,34,36,37]. Thisshould be continued as long as thepatient remains in the nephrotic state.Other modalities that have beenused include low molecular weightheparin, antithrombin III replacement,streptokinase, urokinase, warfarin,and surgical thromboectomy [4,14].The preferred modality will dependupon the associated findings in theindividual case and also upon theexperience of the treating centre[19]. Low molecular weight heparinis being increasingly used as it hasmany advantages like subcutaneousadministration, infrequent monitoring,good safety profile, longer plasmahalf life [12,15,19,20,29]. We usedunfractionated heparin as the initialanticoagulant in our case followedby warfarin after 3 weeks whenimprovement was seen clinically andradiologically. Warfarin was stoppedafter 6 months after completeresolution of the CVST. This is inaccordance to the guidelines ofthe American College of ChestPhysicians [19].Neurological outcome aftertreatment varies [8,17,21,24]. Earlydiagnosis results in a gratifyingoutcome [4,5,19,25,37]. Indicatorsof good cognitive outcome wereearly diagnosis, early initiation ofanti coagulant therapy, older ageof the patient, absence of brainparenchymal lesion and involvementof the lateral or sigmoid sinuses[25]. Patients with younger age,extensive thrombosis, seizures oraltered sensorium at admissionwere associated with adverseoutcome like epilepsy, neurologicaldeficits, cognitive and behaviouralabnormalities which was seenin about half of the patients[17,18,19,20,26,37]. Coma atpresentation is usually associatedwith death [3,20,25]. Early diagnosisand treatment in our case resultedin complete clinical and radiologicalrecovery.ConclusionDiagnosis of CVST should beconsidered in any child with NS whopresents with symptoms suggestiveof increased intracranial pressure orneurological symptoms and signs.CT and MRI of the brain may bediagnostic and should be the initialmodality of choice. However if theseare inconclusive, MRV should bedone.References1. Llach F. Hypercoagulability,renal vein thrombosis, and otherthrombotic complications of nephroticsyndrome. Kidney Int 1985;28(3):429-439.2. Cameron JS. Coagulation andthromboembolic complications in thenephrotic syndrome. Adv NephrolNecker Hosp 1984; 13:75-114.3. Nishi H, Abe A, Kita A, TokiT, Noda N, Tsuchihashi D, et al.Cerebral venous thrombosis in adultnephrotic syndrome due to systemicamyloidosis. Clin Nephrol 2006;65(1):61-64.4. Tullu MS, Deshmukh CT, Save SU,Bhoite BK, Bharucha BA. 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The association ofnephrotic syndrome and renal veinthrombosis: a clinicopathologicalanalysis of eight pediatric patients.42 MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 10 ISSUE 7MIDDLE EAST JOURNAL OF FAMILY MEDICINE • VOLUME 7, ISSUE 10