title: Sagittal sinus thrombosis associated with transient free protein S deficiency after L-asparaginase treatment: case report and review of the literature.
abstract: Cerebral sinus thrombosis associated with acquired free protein S deficiency is very rare. We report the case of an adult patient with acute lymphoblastic leukemia who presented with repeated transient ischemic attacks followed by a seizure during consolidation treatment with L-asparaginase. Magnetic resonance of the brain showed a small cortical hemorrhagic infarct. Superior sagittal sinus thrombosis was demonstrated by cerebral angiogram. A marked decrease of the free form of protein S was documented. One month later, when the patient was free of symptoms, the follow-up free protein S antigen level was restored to the normal range. We suggest that the sagittal sinus thrombosis in this patient was caused by acquired, transient free protein S deficiency. This case also extends the clinical spectrum of cerebral sinus thrombosis to include recurrent transient ischemic attacks alternating with seizures.
authors.affiliation: Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong songpa-gu, Seoul, South Korea. jhlee@www.amc.seoul.kr
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: S W
authors.initials: SW
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Sung Kim
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001215:Asparaginase / Q000009:adverse effects*; D002533:Cerebral Angiography / Q000379:methods; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010291:Paresis / Q000175:diagnosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D018455:Protein S Deficiency / Q000139:chemically induced* / Q000150:complications*; D012851:Sinus Thrombosis, Intracranial / Q000175:diagnosis / Q000209:etiology*
chemical_list: D000970:Antineoplastic Agents; D001215:Asparaginase