# Low molecular weight heparin calcium sequential rivaroxaban for the treatment of cerebral venous sinus thrombosis and cortical venous infarction in children with nephrotic syndrome: case report

## TL;DR

A child with a kidney condition developed a rare brain blood clot and was successfully treated with a specific anticoagulant protocol.

## Contribution

This case report demonstrates the effectiveness of LMWH followed by rivaroxaban in treating CVST in a pediatric nephrotic syndrome patient.

## Key findings

- An 11-year-old with steroid-resistant nephrotic syndrome developed cerebral venous sinus thrombosis.
- Treatment with low-molecular-weight heparin followed by rivaroxaban resolved the thrombus safely.
- MRI and MRV confirmed transverse sinus thrombosis with cortical venous infarction in the patient.

## Abstract

Cerebral venous sinus thrombosis (CVST), though exceedingly rare, represents a serious complication in pediatric patients with nephrotic syndrome (NS). We describe an 11-year-old male with steroid-resistant nephrotic syndrome (SRNS) maintained on prednisone/tacrolimus therapy who subsequently developed CVST. The patient manifested respiratory/gastrointestinal symptoms (cough, diarrhea) followed by neurologic deterioration featuring headache, seizures, and altered consciousness. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) confirmed transverse sinus thrombosis with cortical venous infarction. A 5-day course of low-molecular-weight heparin (LMWH) followed by rivaroxaban achieved safe thrombus resolution, supporting this anticoagulation protocol in pediatric NS.