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

BMC Pediatrics

Alberto Villani⁴  Matteo Luciani²  Annachiara Vittucci⁴  Valeria Calcaterra¹  Giovanna Stefania Colafati³  Mauro Bozzola¹  Elena Bozzola⁴ 

[1] Fondazione IRCCS San Matteo Pavia, Department of Internal Medicine, University of Pavia, Pavia, Italy;Department of Hematology, Oncology and Trasfusion Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy;Neuroradiology Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy;Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

关键词: Thrombophilic evaluation;    Children;    Meningitis;    Cerebral venous sinus thrombosis;   

Others  :  1138775
DOI  :  10.1186/1471-2431-14-147

 received in 2014-02-10, accepted in 2014-05-27,  发布年份 2014

【 摘 要 】

Background

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.

Case presentation

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 7^th 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).

Conclusions

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.

【 授权许可】

   
2014 Bozzola et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 1.

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