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

Elena Bozzola, Mauro Bozzola, Giovanna S. Colafati, Valeria Calcaterra, Annachiara Vittucci, Matteo Luciani, Alberto Villani

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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 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).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.

Original languageEnglish
Article number147
JournalBMC Pediatrics
Volume14
Issue number1
DOIs
Publication statusPublished - Jun 13 2014

Fingerprint

Meningococcal Meningitis
Intracranial Sinus Thrombosis
Intracranial Thrombosis
Venous Thrombosis
Pediatrics
Thrombosis
Neck
Head
Tomography
Transverse Sinuses
Methylenetetrahydrofolate Reductase (NADPH2)
Hyperhomocysteinemia
Lethargy
Ceftriaxone
Delayed Diagnosis
Infection
Anticoagulants
Hospitalization
Inflammation
Physicians

Keywords

  • Cerebral venous sinus thrombosis
  • Children
  • Meningitis
  • Thrombophilic evaluation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Multiple cerebral sinus thromboses complicating meningococcal meningitis : A pediatric case report. / Bozzola, Elena; Bozzola, Mauro; Colafati, Giovanna S.; Calcaterra, Valeria; Vittucci, Annachiara; Luciani, Matteo; Villani, Alberto.

In: BMC Pediatrics, Vol. 14, No. 1, 147, 13.06.2014.

Research output: Contribution to journalArticle

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