*Correspondence: lisandra.coneglian@gmail.com.
Abstract
Case Presentation: P.H.S, 14 years old, previously healthy, with acute headache and hypotension. Progressed
with right dimidium hemiparesis within 24 hours. Neuroimaging-cranial tomography was
performed, suggesting the hypothesis of ischemic stroke. Subsequent nuclear magnetic
resonance imaging of the skull identified venous sinus thrombosis (CSVT) with hemorrhagic
venous infarcts, and anticoagulant treatment was initiated with enoxaparin 1mg/kg/dose
12/12 hours. Three days later, he started with chest pain, a chest image showed pulmonary
thromboembolism. Anticoagulation has been maintained since the onset of the condition.
In the etiological investigative process, alteration in antiphospholipid antibody
was identified with the hypothesis of antiphospholipid antibody syndrome.
Discussion: CSVT is a rare form of stroke with a high mortality rate. The incidence is higher
in women of reproductive age. After the occurrence of a CSVT event, there is an increase
in venular pressure and liquor absorption, culminating in an increase intracranial
pressure, cytotoxic and vasogenic edema, generating local hemorrhagic infarction.
Diagnosis is through neuroimaging, with angiography being the gold standard. As our
case, the signs and symptoms are diverse, headache predominating. Early recognition
and treatment improve outcome in these patients. Anticoagulation with low molecular
weight heparin (LMWH) is the treatment and endovascular thrombolysis is still controversial.
Intracranial hemorrhage is not considered a contraindication to the use of anticoagulants.
The literature recommends anticoagulation with LMWH for at least 5-10 days, followed
by warfarin or LMWH for a minimum of 3 to 6 months for children. The etiological screening
must be carried out in search of infectious, cardiac, neoplastic, rheumatological
diseases, exogenous intoxication, and hematological conditions in the acute phase
of the condition have no investigative value. In the reported case, anticoagulation
with LMWH was initiated from diagnosis and maintained for 3 months. A transition to
oral warfarin was attempted, without success. Regarding prophylactic antiepileptic
therapy, although controversial, the literature claims to be beneficial and levetiracetam
was used in this case. Surveillance of these patients is recommended due to the increased
risk of recurrence of thrombotic conditions.
Final Comments: CSVT is rare. The clinical presentation is variable, the diagnosis is based on neuroimaging
and anticoagulation should be started as soon as possible.
