Deep Cerebral Venous Thrombosis in an 11-Year-Old Female

Abstract

Cerebral venous thrombosis in infants and children has been increasingly recognized during the past several decades. Although associated with a variety of local or systemic conditions, no specific clinical signs suggest cerebral venous thrombosis. Moreover, no specific risk factor can be found in approximately one fourth of the cases. Thus, a correct diagnosis mostly relies on the skillful clinician. This report describes an 11-year-old female who presented with a 12-hour history of vomiting, headache, and abdominal pain which began 3 days after tonsillitis. Twenty-four hours after admission, she manifested altered behavior and clouding of consciousness. Brain computed tomography and magnetic resonance imaging scans, and magnetic resonance angiography disclosed a deep venous thrombosis of the straight sinus, the vein of Galen, and the internal cerebral vein associated with venous right thalamic stroke. No neurologic or physical abnormalities were evident. However, screening for clotting profile identified a heterozygous G20210A mutation in the prothrombin gene. Forty-four hours after admission, she was placed on heparin and then warfarin, which resulted in normal neurologic outcome and radiologic resolution of the thrombosis and infarct.