Dados do Trabalho

Título

CEREBRAL VENOUS THROMBOSIS IN PEDIATRICS - A CASE REPORT

Apresentação do caso

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.

Discussão

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.

Comentários finais

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.

Palavras Chave

Cerebral venous thrombosis, meningitis, thromboembolic events

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