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524 Two Pediatric Cases of Cerebral Venous Sinus Thrombosis with Different Presentations
  1. B Kiliçaslan1,
  2. I˙ Erol2,
  3. N Yazıcı3,
  4. Ö Alkan4
  1. 1Department of Pediatrics
  2. 2Department of Pediatrics, Division of Child Neurology
  3. 3Department of Pediatrics, Division of Child Hematology and Oncology
  4. 4Department of Radiology, Baskent University Hospital, Adana, Turkey

Abstract

Background and Aims Cerebral Venous Sinus Thrombosis (CVST) is a serious and rare disorder in pediatric patients.

Case reports: Case 1: An 8-year-old girl admitted with left middle ear infection, bilateral sixth cranial nerve palsy and papilledema. The Magnetic Resonance Imaging (MRI) venography showed occlusion of superior and inferior sagittal sinus totally and left sigmoid sinüs parsial.Pansinüsitis, left otitis media and mastoiditis were also determined. Evaluation for thrombophilia and tests for specific predisposing conditions were normal. The patient was treated by third generation cephalosporin, clindamycin, acetazolamide and low-molecular weight heparin after the initial diagnosis.

Case 2: A 12-year-old boy presented with aphasia and lethargy after a week of dental infection. Brain MRI and MRI venography demonstrated thalamic enfarct, thrombosis of deep cortical veins, left transverse and sigmoid sinuses.

Evaluation for thrombophilia and tests for specific predisposing conditions were normal. The patient was treated by third generation cephalosporin, clindamycin and low-molecular weight heparin. Two months after the initial diagnosis, the evidence of a small focal thalamic hemorrhage was noted on MRI. Recanalization of venous occlusions were detected on MRI venography.Low-molecular weight heparin therapy was changed with oral acetylsalicylic acid.

Conclusion Since CSVT is an underrecognized cause of intracranial pathologic abnormality in the pediatric population, we wish to draw the attention of pediatricians to the importance of a high level of suspicion for this diagnosis and the preferred diagnostic method which is MRI with venography.

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