Multiple cerebral sinus thromboses complicating meningococcal meningitis: a pediatric case report

• Published in: BMC pediatrics 2014-06, Vol.14 (1), p.147-147, Article 147
• Main Authors: Bozzola, Elena, Bozzola, Mauro, Colafati, Giovanna Stefania, Calcaterra, Valeria, Vittucci, Annachiara, Luciani, Matteo, Villani, Alberto
• Format: Article
• Language: English
• Subjects: Anticoagulants; Blood clot; Care and treatment; Case Report; Case studies; Ceftriaxone; Ceftriaxone sodium; Children & youth; Complications and side effects; Consent; CT imaging; Development and progression; Drug therapy; Health aspects; Hematology; Humans; Hyperhomocysteinemia - diagnosis; Hyperhomocysteinemia - genetics; Infant; Infections; Male; Medical imaging; Meningitis; Meningitis, Meningococcal - complications; Methylenetetrahydrofolate Reductase (NADPH2) - genetics; Molecular weight; Mutation; Neisseria meningitidis; NMR; Nuclear magnetic resonance; Patient outcomes; Proteins; Risk factors; Sinus Thrombosis, Intracranial - complications; Sinus Thrombosis, Intracranial - diagnostic imaging; Sinuses; Studies; Thrombosis; Tomography; Tomography, X-Ray Computed; Visual impairment
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/1471-2431-14-147

Cerebral venous sinus thrombosis (CVT) is a rare and potentially life-threatening condition in the pediatric population. The clinical presentation is frequently nonspecific; thus diagnosis is often delayed or missed. A previously healthy 8 month-old boy was diagnosed with meningococcal meningitis. At hospital admission, an urgent non contrast-enhanced computed tomography (CT) of the head and neck was performed with normal results. Ceftriaxone was promptly started and the clinical condition of the patient improved. However, on the 7th day of hospitalization, the child suddenly manifested irritability and lethargy. An urgent contrast-enhanced CT of the head and neck was immediately performed, revealing thrombosis of the superior sagittal, transverse and rectus sinuses. A thrombophilic evaluation was performed, revealing hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) variants (C677T and A1298C). The causes of CVT may be categorized into three main groups: hypercoagulable states, conditions causing blood flow disturbances, and all causes of inflammation or infection. In this case report, we observed more than one risk factor that predisposed the patient to CVT. Consequently, even if a causative factor is detected, a thrombophilic blood evaluation should be performed. In fact, in case of a prothrombotic condition, the patient's family should be advised that prompt administration of anticoagulant is necessary in the event of situations that could lead to thrombosis. Finally, CVT may be considered a possible complication of infection even when recent imaging results are normal. A prompt CVT diagnosis is required to obtain a good outcome. Delayed diagnosis is mainly due to the rarity of the disease and physicians' unawareness of this type of complication.