An Unusual Case of Cerebral Venous Sinus Thrombosis in a Pediatric Patient

• Published in: The Journal of emergency medicine 2011-03, Vol.40 (3), p.283-286
• Main Authors: Moore, William N., MD, PHD, Cannon, Michael L., MD, FAAP, O'Neill, James C., MD
• Format: Article
• Language: English
• Subjects: altered level of consciousness; Antibiotics; anticoagulants; Anticoagulants - administration & dosage; Cardiopulmonary Resuscitation - methods; Case reports; cerebral venous sinus thrombosis; Child; Critical Care - methods; Drug Therapy, Combination; Drugs; Early Diagnosis; Emergency; Emergency Medical Services; Female; Follow-Up Studies; Head; headache; Heparin - administration & dosage; Humans; Infection; Inflammation; Intensive Care Units; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Overdose; pediatric; Pediatrics; Personnel; Risk Assessment; Risk factors; Severity of Illness Index; Sinus; Sinus Thrombosis, Intracranial - complications; Sinus Thrombosis, Intracranial - diagnosis; Sinus Thrombosis, Intracranial - drug therapy; Sinusitis; thromboembolism; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Unconsciousness - diagnosis; Unconsciousness - etiology; Unconsciousness - therapy; Warfarin - administration & dosage
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2009.05.036

Abstract Background: Cerebral venous sinus thrombosis (CVST) is a rare, but potentially devastating illness. It is important for emergency physicians to be aware of the classic and most common risk factors leading to this illness, including genetic and acquired prothrombotic states, infection, inflammatory conditions, and certain drugs. Objectives: The objectives of this article are to discuss a case of CVST and describe the signs and symptoms of CVST as well as the radiologic modalities used to diagnose this disease. Finally, we will discuss the causes and risk factors that lead to this potentially devastating diagnosis. Case Report: An 11-year-old girl was found unconscious and without pulses in an apparent drug overdose. Emergency Medical Services responders and Emergency Department personnel resuscitated the patient to a return of spontaneous circulation. The patient was intubated and admitted to the intensive care unit. As part of an altered mental status work-up, a magnetic resonance imaging scan of the head was performed and showed a cerebral venous sinus thrombosis. This was thought to be due to the drug overdose and the low-flow state that occurred during loss of circulation. After anticoagulation therapy and antibiotic treatment for sinusitis, the patient had a full recovery. Conclusion: Rapid diagnosis of CVST was essential to the appropriate care of this patient. Being aware of signs, symptoms, and risk factors leading to CVST will assist the emergency physician in making this diagnosis.