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Early Spontaneous Recanalization of Sigmoid Sinus Thrombosis Following a Closed Head Injury in a Pediatric Patient : A Case Report and Review of Literature.

Yun JH, Ko JH, Lee MJ - J Korean Neurosurg Soc (2015)

Bottom Line: The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment.The patient was readmitted for a further examination of his symptoms.The laboratory and the gastroenterological examinations were normal.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Dankook University College of Medicine, Cheonan, Korea.

ABSTRACT
Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.

No MeSH data available.


Related in: MedlinePlus

Brain computed tomography (CT) showed a linear fracture in the right occipital bone (A) and a suspicious intracranial hematoma (B, white arrow) with pneumocephalus (C) around the fracture site. Additionally, a high-density lesion located in right sigmoid sinus was revealed (D, black arrow, "dense vein sign").
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Figure 1: Brain computed tomography (CT) showed a linear fracture in the right occipital bone (A) and a suspicious intracranial hematoma (B, white arrow) with pneumocephalus (C) around the fracture site. Additionally, a high-density lesion located in right sigmoid sinus was revealed (D, black arrow, "dense vein sign").

Mentions: A 10-year-old male fell while riding a bicycle on the road. On the day of the fall, he had no definite symptoms; however, he complained of a mild, intermittent headache and nausea five days after the incident and visited the hospital. His neurological state was normal and there were no blood stains in the ear, nose, or throat. The brain computed tomography (CT) revealed a linear fracture, small amounts of epidural hematomas and pneumocephalus in the right occipital area. When compared to the left side, a higher density lesion within the right sigmoid sinus was found (Fig. 1). The brain magnetic resonance image (MRI) showed the effusion and hemorrhage in the right mastoid air cell and a signal intensity, which was suspected to be thrombus, in the right sigmoid sinus (Fig. 2). The brain magnetic resonance venography (MRV) revealed an absence of a flow signal between the right sigmoid sinus and the jugular bulb, which was confirmed to be sigmoid sinus thrombosis (Fig. 3A). During the physical examination, he showed no papilledema, intracranial hypertension, or otogenic infections such as otitis media. His blood tests, including complete blood count, prothrombin time, partial thromboplastin time, antithrombin III, protein C activity, and protein S activity, were in the normal ranges. The patient was treated conservatively because the patient's symptoms were mild and gradually improved. He was discharged with a full recovery on the 4th day in the hospital. On the 10th day after discharge, the patient complained of vomiting and visited the department of pediatrics. The laboratory tests, including a prothrombotic evaluation and a physical examination, were performed. The results of the laboratory tests were normal. Due to concern regarding the progression of the previous sinus thrombosis, the brain MRV was re-checked, and it showed the recovery of the flow signal in the right sigmoid sinus (Fig. 3B). The spontaneous recanalization of sigmoid sinus thrombosis occurred within about three weeks of the trauma. His vomiting may have been caused by gastrointestinal problems, and it ceased the following day.


Early Spontaneous Recanalization of Sigmoid Sinus Thrombosis Following a Closed Head Injury in a Pediatric Patient : A Case Report and Review of Literature.

Yun JH, Ko JH, Lee MJ - J Korean Neurosurg Soc (2015)

Brain computed tomography (CT) showed a linear fracture in the right occipital bone (A) and a suspicious intracranial hematoma (B, white arrow) with pneumocephalus (C) around the fracture site. Additionally, a high-density lesion located in right sigmoid sinus was revealed (D, black arrow, "dense vein sign").
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4564750&req=5

Figure 1: Brain computed tomography (CT) showed a linear fracture in the right occipital bone (A) and a suspicious intracranial hematoma (B, white arrow) with pneumocephalus (C) around the fracture site. Additionally, a high-density lesion located in right sigmoid sinus was revealed (D, black arrow, "dense vein sign").
Mentions: A 10-year-old male fell while riding a bicycle on the road. On the day of the fall, he had no definite symptoms; however, he complained of a mild, intermittent headache and nausea five days after the incident and visited the hospital. His neurological state was normal and there were no blood stains in the ear, nose, or throat. The brain computed tomography (CT) revealed a linear fracture, small amounts of epidural hematomas and pneumocephalus in the right occipital area. When compared to the left side, a higher density lesion within the right sigmoid sinus was found (Fig. 1). The brain magnetic resonance image (MRI) showed the effusion and hemorrhage in the right mastoid air cell and a signal intensity, which was suspected to be thrombus, in the right sigmoid sinus (Fig. 2). The brain magnetic resonance venography (MRV) revealed an absence of a flow signal between the right sigmoid sinus and the jugular bulb, which was confirmed to be sigmoid sinus thrombosis (Fig. 3A). During the physical examination, he showed no papilledema, intracranial hypertension, or otogenic infections such as otitis media. His blood tests, including complete blood count, prothrombin time, partial thromboplastin time, antithrombin III, protein C activity, and protein S activity, were in the normal ranges. The patient was treated conservatively because the patient's symptoms were mild and gradually improved. He was discharged with a full recovery on the 4th day in the hospital. On the 10th day after discharge, the patient complained of vomiting and visited the department of pediatrics. The laboratory tests, including a prothrombotic evaluation and a physical examination, were performed. The results of the laboratory tests were normal. Due to concern regarding the progression of the previous sinus thrombosis, the brain MRV was re-checked, and it showed the recovery of the flow signal in the right sigmoid sinus (Fig. 3B). The spontaneous recanalization of sigmoid sinus thrombosis occurred within about three weeks of the trauma. His vomiting may have been caused by gastrointestinal problems, and it ceased the following day.

Bottom Line: The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment.The patient was readmitted for a further examination of his symptoms.The laboratory and the gastroenterological examinations were normal.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Surgery, Dankook University College of Medicine, Cheonan, Korea.

ABSTRACT
Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.

No MeSH data available.


Related in: MedlinePlus