title: May headache be the first sign of mutation in the MTHFR gene?
abstract: BACKGROUND
  Cerebral venous thrombosis (CVT) is a rare disease and it has different etiologies. Inherited or acquired prothrombotic state plays a key role in the development of CVT.
  
  
  METHODS
  A 28-year-old man who presented to our emergency department with persistent headache and accompanied by complaints of nausea and vomiting over a week. Neurologic examination revealed bilateral papilledema. Brain computed tomography showed a hyperdense area on the posterior part of the occipital lobe. Brain magnetic resonance imaging and magnetic resonance venography revealed thrombosis of CVT. Homozygous mutations were found for methylenetetrahydrofolate reductase (MTHFR). MTHFR CG677T gene mutation and blood tests showed elevated homocysteine levels on the etiological screening. There was no other etiology for CVT.
  
  
  RESULTS
  Headache and other complaints were improved after treatment of heparin, warfarin, and vitamin B12. No recurrence of symptoms was observed upon outpatient follow-up.
  
  
  CONCLUSIONS
  Since CVT is an important cause of headache, we recommend etiology screening for patients who present with CVT for MTHFR gene mutations and family counseling should be provided.
authors.affiliation: Department of Neurology, School of Medicine, Duzce University, Duzce, Turkey.
authors.forename: Suber
authors.initials: S
authors.lastname: Dikici
authors.affiliation: Department of Emergency Medicine, School of Medicine, Duzce University, Duzce, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Saritas
authors.affiliation: Department of Radiology, School of Medicine, Duzce University, Duzce, Turkey.
authors.forename: Fahri Halit
authors.initials: FH
authors.lastname: Besir
authors.affiliation: Department of Internal Medicine, School of Medicine, Duzce University, Duzce, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Celbek
authors.affiliation: Department of Neurology, School of Medicine, Duzce University, Duzce, Turkey.
authors.forename: Guven
authors.initials: G
authors.lastname: Arslan
keywords: Cerebral venous thrombosis; Headache; Methylenetetrahydrofolate reductase gene mutation