Fetal dural sinus thrombosis: case report and management review

*Correspondence: [e-mail].

Abstract

Case Presentation: The patient was the second child of healthy non-consanguineous parents. Her mother presented only with hypothyroidism during an otherwise uneventful pregnancy. Ultrasound at 30 weeks revealed bilateral ventriculomegaly, hypoplasia of corpus callosum and absent septum pellucidum. Further fetal MRI evidenced thrombosis of the torcular, both transverse sinuses, ⅓ of the straight and sagittal sinus, venous dilatation at parasagittal high convexity and signs of previous hemorrhage in both choroid plexus, symmetrical ventricular dilatation, intraventricular clots, absent septum pellucidum and thin corpus callosum. She was full-term, born in a cesarean birth due to non-reassuring fetal status. She was small for gestational age, normal head circumference and presented with mild global hypotonia. Neonatal brain MRI confirmed fetal findings. No maternal or neonatal coagulopathy or infection was found, and the baby was discharged with no complications at 17 days old.

Discussion: Fetal dural sinus thrombosis (DST) is a rare condition diagnosed antenatally through ultrasound by the identification of an echogenic posterior fossa mass, containing a focal hyperechoic area within. MRI fetal studies provide confirmation of the DST and insight into complications such as ventriculomegaly and local compression. Less than 100 cases are described in literature. To date, there is no evidence to support association with maternal or neonatal coagulopathy, infection or trauma. It has been hypothesized that anatomical malformations of the dural sinus may occur, leading to disturbance of blood circulation and damage of the vascular endothelium. A minority of cases result in fetal or neonatal death and most cases results in decrease or complete resolution of thrombosis antenatally. In majority cases no intervention is needed. If there is hydrocephalus or parenchymal congestion, post-natal anticoagulation and embolization of arteriovenous fistulas should be considered, especially if rapid progression of thrombosis occurs.

Final Comments: We report a rare case of DST. This unusual condition is usually suspected in fetal US and confirmed through MRI. There is no current consensus guideline for treatment, but anticoagulation and embolization should be considered if there are signs of worsening venous hypertension.