European Journal of Molecular & Clinical Medicine

Introduction: Cerebral venous thrombosis is mostly an uncommon but severe
thrombotic manifestation which has a high mortality rate, has the potential to end in
disability and the greater tendency of recurrence. There are some coagulation
abnormalities such as gain-of-function mutations in the genes that encodes factor V
(factor V Leiden) and prothrombin3 are presented with an increased risk of cerebral
vein thrombosis4-6 whereas there are no data currently reported on the role of
hyperhomocysteinemia as a risk factor for cerebral venous thrombosis. High plasma
levels of total homocysteine (tHcy) result from the connection between genetic and
acquired determinants. Cerebral venous thrombosis is one of the commonest causes of
stroke as far as Indian population is concerned. CVST usually predisposes in the state
of pregnancy and puerperium. The pathological hallmark that is reported in CVST is
haemorrhagic infarction. CVST predominantly occur in the young individuals and can
present with a broad spectrum of clinical manifestations which include headache,
altered sensorium, seizures, focal neurological deficits, papilloedema and cranial nerve
palsies. Headache is the most frequent and often the first reported clinical
manifestation. Homocysteine (Hcy) is a sulfhydryl amino acid compound that is
generated from protein breakdown and the essential amino acid methionine as it is
metabolized to cysteine. Hcy can be broken down in two pathways. When there is in
excess methionine, Hcy is directed to transulphuration pathway where it is irreversibly
conjugated to cysteine. Hcy can also be remethylated in a methionine conserving
pathway and this pathway requires folic acid and MTHFR.

Background: Evidence from retrospective and prospective clinical studies indicates that
elevated levels of homocysteine are associated with increased risk of CAD, Ischemic stroke
and peripheral vascular disease. Present study was aimed to study role of Homocysteine as a
risk factor in patients with Acute Vascular Events.
Material and Methods: Present study was prospective, observational study, conducted in
patients with age above 18 years, either gender, admitted for Ischemic heart disease,
peripheral vascular disease, Deep Vein Thrombosis and Pulmonary Thromboembolism.
Results: In this study most of the cases are between the age group of 60-69 years (55%).
Youngest patient in this study is 20 year old. This is a male dominated study with males
comprising 72% of the study group. In this study Dyslipidemia (62%) is the most common
risk factor followed by Smoking (53%). Hypertension (50%) and Diabetes mellitus (41%) are
observed. Family h/o CAD (20%) is present and only (14%) patient was alcoholic.
Overweight is present among 41% of patients. In this study significant number of patients
(72%) have hyperhomocysteinemia. 47% of patients are moderate and 23% are intermediate.
Only 2 patients have severe hyperhomocysteinemia. Mean plasma homocysteine level is
11±3μmol/L and is statistically significant. The mean plasma homocysteine was high among
smokers when compared to non-smokers difference was highly significant. No much
significant difference was noted in mean values of homocysteine among patients with other
high risk factors, such as alcohol consumption, diabetic, dyslipidemia, BMI, family history of
CAD. Hyperhomocysteinemia is seen in 38 out of 51 patients with Cerebrovascular Disease,
32 out of 42 patients with Cardiovascular Disease, one of 4 patients with Peripheral arterial
Disease and one with Deep vein thrombosis.
Conclusion: Plasma homocysteine should be considered as an independent risk factor for the
development of future acute vascular event.