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© 1995 British Society for Rheumatology

case-report

CEREBRAL VENOUS THROMBOSIS AND ACQUIRED PROTEIN S DEFICIENCY: AN UNCOMMON CAUSE OF HEADACHE IN SYSTEMIC LUPUS ERYTHEMATOSUS

C. J. LAVERSUCH, M. M. BROWN*, A. CLIFTON{dagger} and B. E. BOURKE

Department of Rheumatology, St George's Hospital London SW170QT
*Division of Clinical Neurosciences, St George's Hospital Medical School London SW 17 ORE
{dagger}Department of Neuroradiology, Atkinson Morley 's Hospital London SW20 0NG

Correspondence to: Correspondec to: C. J. Laversuch, Department of Rheumatology, St George's Hospital, London SW 17 OQT.

A 42-yr-old woman with hypertension and renal involvement due to systemic lupus erythematosus (SLE) developed unilateral headache followed by the sudden onset of confusion and a grand mal convulsion. Cerebral computed tomography was normal. A magnetic resonance imaging angiogram revealed cerebral venous thrombosis and a venous infarct. Nephrotic syndrome had resulted in an acquired protein S deficiency. A review of previous cases suggests that either renal disease with proteinuria or features of the antiphospholipid syndrome are prerequisites for the development of cerebral venous thrombosis in SLE. Low free-protein S levels may be an additional risk factor. Furthermore it is likely that this condition is underdiagnosed.

KEY WORDS: Cerebral venous thrombosis, Systemic lupus erythematosus, Protein S, Magnetic resonance imaging, Nephrotic syndrome


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