{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:47Z","timestamp":1776096467911,"version":"3.50.1"},"reference-count":42,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,1,26]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Cerebral venous sinus thrombosis (CVST) is a rare stroke subtype (0.5%\u20133%) that frequently presents with nonspecific symptoms, delaying diagnosis. Although hyperhomocysteinemia is a known risk factor, acquired cases resulting from severe vitamin B12 and folate deficiencies can be easily overlooked by clinicians in any setting, making this a critical yet preventable cause of life-threatening thrombosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 44-year-old man with obesity, who adopted a carbohydrate-heavy diet and consumed excessive alcohol (70\u2013140 g\/day) following a major life event 3 years prior, presented with worsening headache, somnolence, and right-sided neurological deficits. Imaging confirmed CVST with bilateral parietal venous infarction and left-sided hemorrhage. Severe hyperhomocysteinemia (143.4 nmol\/mL) secondary to critically low vitamin B12 and folate levels was identified, likely induced by these lifestyle changes. Anticoagulation therapy, vitamin supplementation, alcohol cessation, and nutritional counseling improved clinical symptoms, with normalization of homocysteine levels within 30 days, despite persistent evidence of brain tissue damage on imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case highlights the serious consequences of severe vitamin deficiencies, triggered by lifestyle changes, in causing significant CVST, regardless of location. It emphasizes the importance of prioritizing detailed history-taking to identify modifiable lifestyle factors, facilitating timely intervention to manage symptoms, normalize homocysteine levels, and prevent recurrence.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25759\">https:\/\/thejns.org\/doi\/10.3171\/CASE25759<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25759","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T06:29:20Z","timestamp":1769408960000},"source":"Crossref","is-referenced-by-count":0,"title":["Preventable cerebral venous sinus thrombosis from diet- and alcohol-induced hyperhomocysteinemia: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Saaya","family":"Maruyama","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiyoyuki","family":"Yanaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minami","family":"Saura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2144-663X","authenticated-orcid":true,"given":"Toshihide","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Aiyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tsukuba Memorial Hospital, Tsukuba, Ibaraki"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7172-7608","authenticated-orcid":true,"given":"Aiki","family":"Marushima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiichi","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Institute of Medicine, University of Tsukuba, Ibaraki, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Stroke","first-page":"e77","article-title":"Diagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association","volume":"55","author":"Saposnik","year":"2024","unstructured":"Saposnik GBushnell CCoutinho JMDiagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association. Stroke. 2024;55(3):e77-e90."},{"issue":"3","key":"bib2","series-title":"Stroke","first-page":"664","article-title":"Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on cerebral vein and Dural Sinus Thrombosis (ISCVT)","volume":"35","author":"Ferro","year":"2004","unstructured":"Ferro JMCanh\u00e3o PStam JBousser MGBarinagarrementeria FISCVT Investigators.Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on cerebral vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35(3):664-670."},{"issue":"9176","key":"bib3","series-title":"Lancet","first-page":"407","article-title":"Homocysteine and vascular disease","volume":"354","author":"Hankey","year":"1999","unstructured":"Hankey GJEikelboom JW.Homocysteine and vascular disease. Lancet. 1999;354(9176):407-413."},{"issue":"3","key":"bib4","series-title":"Indian J Med Res","first-page":"279","article-title":"Influence of folic acid on plasma homocysteine levels and arterial endothelial function in patients with unstable angina","volume":"129","author":"Guo","year":"2009","unstructured":"Guo HChi JXing YWang P.Influence of folic acid on plasma homocysteine levels and arterial endothelial function in patients with unstable angina. Indian J Med Res. 2009;129(3):279-284."},{"issue":"4","key":"bib5","series-title":"J Epidemiol","first-page":"125","article-title":"Relationship between smoking status and tooth loss: findings from national databases in Japan","volume":"17","author":"Hanioka","year":"2007","unstructured":"Hanioka TOjima MTanaka KAoyama H.Relationship between smoking status and tooth loss: findings from national databases in Japan. J Epidemiol. 2007;17(4):125-132."},{"issue":"1","key":"bib6","series-title":"Sci Rep","first-page":"883","article-title":"Diagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis","volume":"10","author":"Tayyebi","year":"2020","unstructured":"Tayyebi SAkhavan RShams MDiagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis. Sci Rep. 2020;10(1):883."},{"issue":"8","key":"bib7","series-title":"Neurochem Res","first-page":"1485","article-title":"Toxic effects of mildly elevated homocysteine concentrations in neuronal-like cells","volume":"39","author":"Curr\u00f2","year":"2014","unstructured":"Curr\u00f2 MGugliandolo AGangemi CRisitano RIentile RCaccamo D.Toxic effects of mildly elevated homocysteine concentrations in neuronal-like cells. 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Indian J Med Res. 2020;152(6):584-594."},{"issue":"1","key":"bib16","series-title":"Case Rep Crit Care","first-page":"1468704","article-title":"Cerebral venous sinus thrombosis and hydrocephalus in a vegan secondary to acquired hyperhomocystinaemia","volume":"2019","author":"Priyankara","year":"2019","unstructured":"Priyankara WDDChandimal AVISivagnanam FGManoj EM.Cerebral venous sinus thrombosis and hydrocephalus in a vegan secondary to acquired hyperhomocystinaemia. Case Rep Crit Care. 2019;2019(1):1468704."},{"issue":"8767","key":"bib17","series-title":"Lancet","first-page":"597","article-title":"Heparin treatment in sinus venous thrombosis","volume":"338","author":"Einh\u00e4upl","year":"1991","unstructured":"Einh\u00e4upl KMVillringer AMeister WHeparin treatment in sinus venous thrombosis. Lancet. 1991;338(8767):597-600."},{"issue":"10","key":"bib18","series-title":"Eur J Neurol","first-page":"1203","article-title":"European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis\u2014endorsed by the European Academy of Neurology","volume":"24","author":"Ferro","year":"2017","unstructured":"Ferro JMBousser MGCanh\u00e3o PEuropean Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis\u2014endorsed by the European Academy of Neurology. Eur J Neurol. 2017;24(10):1203-1213."},{"issue":"8","key":"bib19","series-title":"Cochrane Database Syst Rev","first-page":"CD002005","article-title":"Anticoagulation for cerebral venous sinus thrombosis","volume":"2011","author":"Coutinho","year":"2011","unstructured":"Coutinho Jde Bruijn SFTMDeveber GStam J.Anticoagulation for cerebral venous sinus thrombosis. Cochrane Database Syst Rev. 2011;2011(8):CD002005."},{"issue":"5","key":"bib20","series-title":"Stroke","first-page":"1263","article-title":"Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases","volume":"46","author":"Siddiqui","year":"2015","unstructured":"Siddiqui FMDandapat SBanerjee CMechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke. 2015;46(5):1263-1268."},{"key":"bib21","series-title":"Postepy Hig Med Dosw (Online)","first-page":"579","article-title":"Hyperhomocysteinemia in patients with cardiovascular disease","volume":"68","author":"Baszczuk","year":"2014","unstructured":"Baszczuk AKopczy\u0144ski Z.Hyperhomocysteinemia in patients with cardiovascular disease. Postepy Hig Med Dosw (Online). 2014;68:579-589."},{"issue":"3","key":"bib1","series-title":"Stroke","first-page":"e77","article-title":"Diagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association","volume":"55","author":"Saposnik","year":"2024","unstructured":"Saposnik GBushnell CCoutinho JMDiagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association. 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J Epidemiol. 2007;17(4):125-132."},{"issue":"1","key":"bib6","series-title":"Sci Rep","first-page":"883","article-title":"Diagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis","volume":"10","author":"Tayyebi","year":"2020","unstructured":"Tayyebi SAkhavan RShams MDiagnostic value of non-contrast brain computed tomography in the evaluation of acute cerebral venous thrombosis. Sci Rep. 2020;10(1):883."},{"issue":"8","key":"bib7","series-title":"Neurochem Res","first-page":"1485","article-title":"Toxic effects of mildly elevated homocysteine concentrations in neuronal-like cells","volume":"39","author":"Curr\u00f2","year":"2014","unstructured":"Curr\u00f2 MGugliandolo AGangemi CRisitano RIentile RCaccamo D.Toxic effects of mildly elevated homocysteine concentrations in neuronal-like cells. Neurochem Res. 2014;39(8):1485-1495."},{"issue":"1","key":"bib8","series-title":"Nutr J","first-page":"6","article-title":"Role of homocysteine in the development of cardiovascular disease","volume":"14","author":"Ganguly","year":"2015","unstructured":"Ganguly PAlam SF.Role of homocysteine in the development of cardiovascular disease. Nutr J. 2015;14(1):6."},{"issue":"4","key":"bib9","series-title":"Blood","first-page":"1363","article-title":"Hyperhomocysteinemia in cerebral vein thrombosis","volume":"102","author":"Martinelli","year":"2003","unstructured":"Martinelli IBattaglioli TPedotti PCattaneo MMannucci PM.Hyperhomocysteinemia in cerebral vein thrombosis. 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Swiss Med Wkly. 2006;136(47-48):745-756."},{"issue":"8","key":"bib12","series-title":"Stroke","first-page":"1790","article-title":"Hyperhomocysteinemia, low folate and vitamin B12 concentrations, and methylene tetrahydrofolate reductase mutation in cerebral venous thrombosis","volume":"35","author":"Cantu","year":"2004","unstructured":"Cantu CAlonso EJara AHyperhomocysteinemia, low folate and vitamin B12 concentrations, and methylene tetrahydrofolate reductase mutation in cerebral venous thrombosis. Stroke. 2004;35(8):1790-1794."},{"issue":"5","key":"bib13","series-title":"JAMA","first-page":"579","article-title":"Alcohol consumption and risk of stroke: a meta-analysis","volume":"289","author":"Reynolds","year":"2003","unstructured":"Reynolds KLewis BNolen JDLKinney GLSathya BHe J.Alcohol consumption and risk of stroke: a meta-analysis. JAMA. 2003;289(5):579-588."},{"issue":"2","key":"bib14","series-title":"Neurol India","first-page":"154","article-title":"Risk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: insights from Nizam\u2019s Institute venous Stroke Registry, Hyderabad (India)","volume":"60","author":"Narayan","year":"2012","unstructured":"Narayan DKaul SRavishankar KRisk factors, clinical profile, and long-term outcome of 428 patients of cerebral sinus venous thrombosis: insights from Nizam\u2019s Institute venous Stroke Registry, Hyderabad (India). Neurol India. 2012;60(2):154-159."},{"issue":"6","key":"bib15","series-title":"Indian J Med Res","first-page":"584","article-title":"A study of hyperhomocysteinemia in cerebral venous sinus thrombosis","volume":"152","author":"Kalita","year":"2020","unstructured":"Kalita JSingh VKMisra UK.A study of hyperhomocysteinemia in cerebral venous sinus thrombosis. 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Lancet. 1991;338(8767):597-600."},{"issue":"10","key":"bib18","series-title":"Eur J Neurol","first-page":"1203","article-title":"European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis\u2014endorsed by the European Academy of Neurology","volume":"24","author":"Ferro","year":"2017","unstructured":"Ferro JMBousser MGCanh\u00e3o PEuropean Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis\u2014endorsed by the European Academy of Neurology. Eur J Neurol. 2017;24(10):1203-1213."},{"issue":"8","key":"bib19","series-title":"Cochrane Database Syst Rev","first-page":"CD002005","article-title":"Anticoagulation for cerebral venous sinus thrombosis","volume":"2011","author":"Coutinho","year":"2011","unstructured":"Coutinho Jde Bruijn SFTMDeveber GStam J.Anticoagulation for cerebral venous sinus thrombosis. 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