Cerebral Sinus Thrombosis in a 6-Year-Old Boy After a Minor Head Injury

Lebowitz, David; Ko, Melissa W.; Cameron, Ella K.; Ko, Paul

doi:10.1097/pec.0000000000000088

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…CVT has been associated with various etiologies including hypercoagulable states, head trauma, dehydration, oral contraceptives use, neoplastic invasion of a venous sinus, vasculitis, intracranial and systemic infections, congenital heart disease, anemia, pregnancy, and puerperium. [ 4 ] Oral contraceptive use is the only known risk factor in our patient. In addition to the absence of risk factors such as trauma, systemic or intracranial infection, dehydration, and vasculitis, the extensive laboratory evaluation for prothrombotic conditions showed normal findings.…”

Section: Discussionmentioning

confidence: 97%

Facial palsy in cerebral venous thrombosis: An atypical case in a young girl

Kartal

2017

J Pediatr Neurosci

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Cerebral venous thrombosis (CVT) is a rare and potentially life-threating cause of stroke. A number of etiologies and risk factors for CVT have been identified so far. These include head trauma, local and systemic infectious diseases, malignancies, autoimmune diseases, and oral contraceptive use. The most common clinical symptoms are headache and changes in consciousness. Cranial nerve palsy in CVT is uncommon, and there are very few reports of facial nerve palsy. This case report highlights an atypical manifestation in a CVT patient, who presented with peripheral facial palsy. The patient was successfully treated with anticoagulation.

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Section: Discussionmentioning

confidence: 97%

Facial palsy in cerebral venous thrombosis: An atypical case in a young girl

Kartal

2017

J Pediatr Neurosci

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“…When there is adequate collateral venous circulation, or thrombosis occurs in a nondominant sinus, the patient may even be asymptomatic, which requires an even higher index of suspicion. 31 Historically, therefore, it has often been the presence of a skull fracture close to a venous sinus or an adjacent epidural hematoma that prompts workup for cerebral venous sinus pathology. In our series, this proximity of the fracture to a venous sinus was the most common reason that venous imaging was performed.…”

Section: Discussionmentioning

confidence: 99%

“…In our series, this proximity of the fracture to a venous sinus was the most common reason that venous imaging was performed. Although traumatic CVST has been found in the absence of a fracture, 31,51,52,56,62 various authors have identified a skull fracture overlying a dural venous sinus as an independent risk factor for sinus thrombosis. 11,31,42,45,56 Delgado Almandoz et al 11 found that among 159 pediatric and adult patients who presented to the emergency department with skull fractures, 57 patients (36%) had positive findings on CTV; all cases of thrombosis occurred in patients whose fracture extended to a dural venous sinus or the jugular bulb (which was the case in 140 of 159 patients).…”

Section: Discussionmentioning

confidence: 99%

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Pediatric cerebral venous sinus thrombosis or compression in the setting of skull fractures from blunt head trauma

Hersh¹,

Shimony

Groves³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEPediatric cerebral venous sinus thrombosis has been previously described in the setting of blunt head trauma; however, the population demographics, risk factors for thrombosis, and the risks and benefits of detection and treatment in this patient population are poorly defined. Furthermore, few reports differentiate between different forms of sinus pathology. A series of pediatric patients with skull fractures who underwent venous imaging and were diagnosed with intrinsic cerebral venous sinus thrombosis or extrinsic sinus compression is presented.METHODSThe medical records of patients at 2 pediatric trauma centers were retrospectively reviewed. Patients who were evaluated for blunt head trauma from January 2003 to December 2013, diagnosed with a skull fracture, and underwent venous imaging were included.RESULTSOf 2224 pediatric patients with skull fractures following blunt trauma, 41 patients (2%) underwent venous imaging. Of these, 8 patients (20%) had intrinsic sinus thrombosis and 14 patients (34%) displayed extrinsic compression of a venous sinus. Three patients with intrinsic sinus thrombosis developed venous infarcts, and 2 of these patients were treated with anticoagulation. One patient with extrinsic sinus compression by a depressed skull fracture underwent surgical elevation of the fracture. All patients with sinus pathology were discharged to home or inpatient rehabilitation. Among patients who underwent follow-up imaging, the sinus pathology had resolved by 6 months postinjury in 80% of patients with intrinsic thrombosis as well as 80% of patients with extrinsic compression. All patients with intrinsic thrombosis or extrinsic compression had a Glasgow Outcome Scale score of 4 or 5 at their last follow-up.CONCLUSIONSIn this series of pediatric trauma patients who underwent venous imaging for suspected thrombosis, the yield of detecting intrinsic thrombosis and/or extrinsic compression of a venous sinus was high. However, few patients developed venous hypertension or infarction and were subsequently treated with anticoagulation or surgical decompression of the sinus. Most had spontaneous resolution and good neurological outcomes without treatment. Therefore, in the setting of pediatric skull fractures after blunt injury, venous imaging is recommended when venous hypertension or infarction is suspected and anticoagulation is being considered. However, there is little indication for pervasive venous imaging after pediatric skull fractures, especially in light of the potential risks of CT venography or MR venography in the pediatric population and the unclear benefits of anticoagulation.

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“…There are several studies about CVST following a closed head injury in pediatrics ( Table 1 ). Twenty-three patients in 11 studies have been reported 8 9 13 16 17 20 22 23 25 26) . The frequently involved locations were the sigmoid sinus (69.6%) and the transverse sinus (52.2%).…”

Section: Discussionmentioning

confidence: 99%

Early Spontaneous Recanalization of Sigmoid Sinus Thrombosis Following a Closed Head Injury in a Pediatric Patient : A Case Report and Review of Literature

Yun

Lee

2015

J Korean Neurosurg Soc

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Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.

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Cerebral Sinus Thrombosis in a 6-Year-Old Boy After a Minor Head Injury

Cited by 6 publications

References 8 publications

Facial palsy in cerebral venous thrombosis: An atypical case in a young girl

Facial palsy in cerebral venous thrombosis: An atypical case in a young girl

Pediatric cerebral venous sinus thrombosis or compression in the setting of skull fractures from blunt head trauma

Early Spontaneous Recanalization of Sigmoid Sinus Thrombosis Following a Closed Head Injury in a Pediatric Patient : A Case Report and Review of Literature

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