We report a 9-year-old boy with acute lymphoblastic leukemia (ALL) in high-risk group who suffered from left sided focal seizures and ipsilateral hemiparesis during his induction with Asparaginase chemotherapy. Superior sagittal sinus thrombosis and right frontal hemorrhage were demonstrated on brain magnetic resonance imaging (MRI) scans . Anticoagulation was initiated with unfractionated heparin and switched to low molecular weight heparin after 3？weeks and continued for 6？months. At one-year followup, he had complete response to chemotherapy for ALL, with residual mild left hemiparesis, and his MRI scans revealed recanalized venous sinuses. The case highlights the importance of considering cerebral venous thrombosis as a complication of Asparaginase therapy. 1. Introduction Cerebral venous sinus thrombosis (CVST) in children is rare. However, CVST is being increasingly recognized because of greater clinical awareness among clinicians, availability of sensitive neuroimaging techniques, and the survival of children with previously lethal diseases that confer a predisposition to sinovenous thrombosis [1]. One such predisposing condition is acute lymphoblastic leukemia (ALL) and its intensive induction chemotherapy. The importance of chemotherapy in the pathogenesis of ALL-associated CVST is indicated by the observation that over 90% of cases occur during induction therapy; therefore, research has focused on chemotherapeutic agents administered and their influence on hemostasis [2]. Alterations in hemostasis have been well documented in children receiving Asparaginase as a single agent or in combination with prednisolone [2–5]. Cerebral venous sinuses thrombosis is a unique feature of Asparaginase-related thrombosis and is reported to occur in 1%–3% of patients [2]. Herein, we report a case of CVST in a 9-year-old boy undergoing induction chemotherapy for ALL. The correlation of CVST with hypercoagulable state, clinical-radiological features, and treatment are discussed. 2. Case Report A 9-year-old boy presented to emergency department with headache and focal seizures of 1-day duration. He was newly diagnosed, on February 2012, with ALL and was just started his daily oral prednisolone, daunorubicin, weekly intravenous vincristine, and intrathecal chemotherapy. On day 3 of induction protocol, intramuscular polyethylene glycosylated- (PEG-) Asparaginase, the polyethylene glycol conjugate of E. coli L-Asparaginase (2500？IU/m2) was administered. His symptoms started on day 24 of induction protocol; he started complaining of severe headache and developed
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