Cerebral venous thrombosis in pediatrics: a case report

*Correspondence: [e-mail].

Abstract

Case Presentation: E.M.B.C., an 11-year-old male, was referred to our service due to complaints of severe headache associated with vomiting for 15 days, with intermittent fever during this period. He had a history of viral meningitis one month prior, remaining asymptomatic during treatment. On physical examination, he was prostrate, with mild neck stiffness, without other alterations. A new liquor collection was performed, without alterations; a computed tomography (CT) scan of the skull showed no changes; a magnetic resonance imaging (MRI) of the skull showed questionable filling defects in the dural venous sinuses, more evident in the left transverse sinus; magnetic resonance angiography of the encephalic venous drainage showed extensive filling defect in the internal jugular vein, sigmoid sinus, and left transverse sinus, extension through the torcula, slight extension to the adjacent superior sagittal sinus and extending through the right transverse sinus, compatible with cerebral venous thrombosis. Further screening for prothrombotic conditions was performed, without changes. Treatment with enoxaparin 2mg/kg/day was initiated, with improvement of symptoms and neuroimaging after 72 hours of treatment.

Discussion: Thromboembolic events in the pediatric population, although uncommon, have high morbimortality, with an incidence of 0.07:100,000 children, but with an increased incidence of 60:10,000 in hospitalized children. The mechanisms involved in their occurrence are blood stasis, changes in the vascular wall, and hypercoagulability, and occur due to multifactorial conditions involving genetic and acquired risk factors. Among the main risk factors involved, we can mention hereditary thrombophilias, the use of central venous catheter, infections, trauma, neoplasia, dehydration, among others. Clinical manifestations may vary according to age and include headache, diplopia, cranial nerve paralysis, nausea, and vomiting. The diagnosis is made through magnetic resonance angiography, and investigation for hereditary thrombophilias is recommended in all patients with a diagnosis of thrombosis. Treatment is based on anticoagulation and multiprofessional follow-up. Prognosis is based on the extent of vessel and brain parenchyma involvement, diagnosis, and treatment implementation.

Final Comments: In view of this clinical case, the importance of diagnostic suspicion and investigation with possible complications of conditions that did not improve or worsened after appropriate treatment is reinforced.

 

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Publication History

Article published online:
12 May 2025