cerebro - vascular diseases are one of the top 10 causes of mortality and morbidity in children . current figures suggest the incidence of 25/100,000 children / year for childhood stroke and at least 300 children in the united kingdom are diagnosed with stroke per year . cerebral sino - venous thrombosis ( csvt ) is a rare but serious cause of stroke in children . various risk factors have been identified in the literature including dehydration , sepsis , inflammatory diseases , and prothrombotic factors . iron deficiency anemia ( ida ) is a common pediatric problem affecting up to 25% of all the children worldwide . in an american survey 9% of children 1 - 2 years of age , 3% of children 3 - -5 years of age , and 2% of children 6 - 11 years of age were found to be iron deficient . a young nine - month - old boy of asian origin presented to our hospital with 1 day history of mild temperature , vomiting , and coryzal symptoms . he was born out of nonconsanguineous marriage and is the only child of his parents . he had a normal birth and development , and was up to date with his immunizations . there was no family history of any serious neurological conditions or strokes . on initial examination he was noted to be very pale and had a systolic murmur over the precordium . g / l , platelets 866 , white cell count 14 , mean corpuscular volume ( mcv ) 48 , mean corpuscular hemoglobin ( mch ) 11 , reticulocyte count 22 , and total iron of 7 g / l . after 7 days of hospitalization , he suddenly became drowsy and encephalopathic with gcs of 9/15 . mr venogram ( mrv ) confirmed extensive thrombosis of internal cerebral vein , vein of galen , straight sinus , sigmoid sinus , and basal vein of rosenthal [ figure 1 ] . magnetic resonance imaging and mr venogram done after the acute illness demonstrating bilateral thalamic infarction with hemorrhagic transformation and extensive venous sinus thrombosis he was started on low molecular weight heparin ( lmwh ) . ida has been linked with various neurological complications like motor developmental delay , behavioural problems , breath holding spells , stroke , pseudotumor cerebri and cranial nerve palsies . ida has also been associated with csvt as described in some case reports and case series in the pediatric literature . described six children aged between 6 and 18 months , who developed stroke with anemia . all children had preceding mild viral infection of either the upper respiratory or gastrointestinal tract . in a case control study by maguire et al . , anemia was significantly more common in children with stroke than in controls ( 53% vs. 9% ) . previously healthy children who developed vaso - occlusive stroke are 10 times more likely to have ida than healthy children , who do not develop stroke . iron deficiency can increase the number of platelets in blood , which is linked with a hypercoagulable state . it has been found that microcytosis decreases the cell deformability and increase the viscosity , causing abnormal flow patterns . under conditions of stress or infections , the metabolic demand at the tissue level rises which can create anemic hypoxia and can predispose to venous thrombosis . no other predisposing factors for csvt were present like sepsis , trauma , autoimmune diseases or prothrombotic disorders . management of csvt involves anticoagulation therapy ( act ) and symptomatic measures such as hydration , antimicrobials , control of seizures with anticonvulsants and management of raised intracranial pressure . unfractionated heparin or low molecular weight heparin ( lmwh ) is recommended in the absence of any major hemorrhage in older children , except in neonates . repeat venous imaging is recommended after 3 months to evaluate for recanalization and resolution of clot . if venous sinuses are partially recanalized , treatment should be continued for at least 6 months . thrombolysis , thrombectomy or surgical decompression has only been used in isolated cases in seriously ill patients or in those with worsening thrombosis despite adequate anticoagulation . in the study by kenet the predictors of recurrent thromboses included persistent occlusion on follow - up venous imaging , heterozygosity for the g20210a mutation in factor ii and the lack of anticoagulant therapy . children with severe ida should be actively treated and monitored , especially during minor infections because of the risk for developing csvt .
iron deficiency anemia is a common pediatric problem affecting up to 25% children worldwide . 
 it has been linked with cerebral venous sinus thrombosis in the literature . 
 we describe a 9-month - old child who had severe iron deficiency anemia and developed acute venous sinus thrombosis associated with minor infection . 
 treatment with anticoagulation was partially successful with persistent thrombosis after 3 months . 
 we reviewed the current literature highlighting the association of anemia as a risk factor for development of stroke in children .