PMC5542071_01
(a) Sagittal T1-weighted image shows increased signal from subacute thrombus in the superior sinus, (b) sagittal 2D PC MRV shows absence of signal from the anterior two-thirds of the superior sagittal sinus due to occlusion and (c) sagittal 2D PC MRV shows recanalisation of the superior sagittal sinus at 6 months follow-up.
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Dietary compliance to treatment had initially been good but gradually deteriorated in the 6 years prior to presentation as reflected by infrequent blood sampling and rising free homocystine levels (Figure 1). T1-weighted MRI of brain showed increased signal in the superior sagittal sinus anteriorly (Figure 1(a)), corresponding to an absence of signal from the anterior two-thirds of the sinus on two-dimensional phase-contrast magnetic resonance venography (2D PC MRV; Figure 1(b)). There was no evidence of venous infarction on MRI despite the focal neurological findings. A repeat MRI/MRV brain at 6-month follow-up revealed complete recanalisation of the superior sagittal sinus (Figure 1(c)).
Dietary natural protein intake with corresponding total and free homocysteine levels.
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Free homocystine (fHcy) and total homocysteine (tHcy) levels on admission were markedly elevated at 86 and 290 mumol/L (normal: 0 and <15; Figure 2), respectively. It was gradually reintroduced and titrated to maintain serum-free homocystine < 5 mumol/L and total homocysteine < 50 mumol/L (Figure 2). Serum-free homocystine and total homocysteine were reduced to <5 and <50 mumol/L, respectively, from day 3 of admission and have been maintained at this level (Figure 2).