Thrombosis of the Posterior Inferior Cerebellar Artery Secondary to Nephrotic Syndrome

Dr. Ramón Ruiz de Gauna, C/José Lejarreta No 12, E-01003 Vitoria-Gasteiz (Spain) Dear Sir, Thromboembolic complications in nephrotic syndrome, a condition frequently found in association with membranous ne-phropathy, have long been recognized as the result of a hypercoagulable state [1, 2]. Although arterial thrombosis is much less common than venous thrombosis, nephrotic syndrome complicated by thrombosis in the cerebral arterial territories [3,4] has been occasionally described. The present case appears to be the first for thrombosis of the posterior inferior cerebellar artery (Wallenberg syndrome) secondary to idiopathic membranous nephropathy and the nephrotic syndrome. A 45-year-old previously healthy man presented a clinical diagnosis of Wallenberg syndrome. Initial serum biochemistry disclosed hypoproteinemia (serum albumin 22.7 g/l). A 24-hour collection of urine contained > 3.5 g of protein with renal function tests within normal limits. Percutaneous renal biopsy was performed and the diagnosis of type I idiopathic membranous glomerulo-nephritis and Wallenberg syndrome secondary to arterial thrombosis was made. Coagulation tests were normal except fi-brinogen 12.4 g/l (1,249 mg%). An increased risk of thromboembolic complications among patients with membranous nephropathy has been associated with an inverse relation between ñbrinogen concentrations and serum albumin levels [5, 6]. This case illustrates that thrombosis in the posterior inferior cerebellar artery needs to be considered in the list of extracardiac arterial thromboses in the nephrotic syndrome. References Llach F: Thromboembolic complications in nephrotic syndrome. Coagulation abnormalities, renal vein thrombosis, and other conditions. Postgrad Med 1984;76:111-123. Donadio JV Jr, Torres VΕ, Velosa JA, Wagoner RD, Holley KE, Okamura M, Ilstrup DM, Chu C-P: Idiopathic membranous nephropathy: The natural history of untreated patients. Kidney Int 1988;33:708715. Parag KB, Somers SR, Seedat YK, Byrne S, Da Cruz CMA, Kenoyer G: Arterial thrombosis in nephrotic syndrome. Am J Kidney Dis 1990; 15:176-177. Nigond J, Grolleau-Raoux R: Thrombose ca-rotidienne et infarctus du myocarde au cours d’un syndrome néphrotique. Arch Mai Cæur 1990;83:105-108.