Case Report
Volume 3 Issue 7 - 2020
A Case of Resolved Cerebral Venous Sinus Thrombosis after Prolong Ventilatory Support with No Neurological Deficit
Amin Ali1, Adnan Mirza2*, Muhammad Salat2, Khalil Ahmad2, Waqar Khowaja1 and Sehar Ali3
1Fellow Neonatal Fellowship Programme, The Aga Khan University Hospital, Karachi, Pakistan
2Faculty of Paediatrics, Neonatal Intensive Neonatal Care Unit, The Aga Khan University Hospital, Karachi, Pakistan
3Resident of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan
*Corresponding Author: Adnan Mirza, Faculty of Paediatrics, Neonatal Intensive Neonatal Care Unit, The Aga Khan University Hospital, Karachi, Pakistan.
Received: March 04, 2020; Published: June 30, 2020




Abstract

Neonatal Cerebrovenous sinus thrombosis (CVST) is extremely rare, however it is a devastating condition and one needs to be aware of this condition to diagnose it. The risk factors for CVST are still not properly understood. The largest registry for stroke and for neonatal CVST is from the Canadian registry which quotes an incidence of 0.6 per 100,000 population per year. No data is present for the neonatal CVST in this region. To date there is no consensus on the role of anticoagulant therapy and therefore therapy is largely supportive, however individual cases have to be evaluated and treated on merit.

We use detailed retrospective review of chart as a methodology to ascertain our findings and all relevant laboratory investigations were fetched from the internal lab data for the case study.

The site of CSVT in newborns reflects distribution in adults and children, as this condition is more frequent in the superficial system than in the deep venous system (approximately one-third of the case of CSVT in newborns affects deep veins. Data on the correlation between the extent and location of clots and associated brain lesions have been reported [3]. Such correlations between venous anatomy and hemorrhagic injury is well known in premature children, where the persistence of the germinal matrix on the caudal scar is known. Germinal matrix causes intraventricular hemorrhage with possible later medieval venous infarction [4,5]. Thrombosis usually begins in the vicinity of the parietal lobe within the superior Sagittarius sinus, probably due to the peculiar course of the posterior frontal, parietal and occipital nerves. Management of neonatal CSVT is urgent, if necessary, with the treatment of any underlying condition and anticonvulsants. Anticoagulation therapy is controversial. The rationale for anticoagulation in CSVT is to prevent thrombus expansion and recurrence, favor spontaneous thrombus resolution, and prevent further brain damage due to hemorrhagic infarction. Anticoagulation with incomplete heparin and low molecular weight heparin (LMWH) is safe in pediatric patients with venous thrombosis of the brain [6]. Therefore, the risk of heparin-induced intracerebral bleeding is against the risk of bleeding due to progressive thrombosis.

Our case showed that appropriate and urgent management of a complicated case of cerebral venous sinus thrombosis (CVST), who was initially ventilated can become better and fully recovered despite controversial management of Anti-thrombolytic activity. The other important finding we observed was sudden improvement of our baby with removal of ventilatory support along with improvement of MRI findings.

Keywords: Cerebral Venous Sinus Thrombosis (CVST); Ventilatory Support; Neurological Deficit

Citation: Adnan Mirza., et al. “A Case of Resolved Cerebral Venous Sinus Thrombosis after Prolong Ventilatory Support with No Neurological Deficit”. EC Clinical and Medical Case Reports 3.8 (2020): 38-41.

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