P0020 / #1115: ASPIRATION THROMBECTOMY IN AN ADOLESCENT MALE PRESENTING WITH BILATERAL CEREBRAL VENOUS THROMBOSIS: CASE REPORT AND REVIEW OF LITERATURE FROM AN LOWER MIDDLE INCOME COUNTRY

Abstract

Aims & Objectives: Bilateral Cerebral Venous Thrombosis (CVT) is a rare clinical presentation in the adolescent population and therefore offers a diagnostic challenge. The purpose of reporting this case is that the novel use of EMT in an adolescent with bilateral CVT has not been reported before and should be considered in as an emergent therapeutic adjunct in a similar case presentation. Methods: We present the case of a 17 year old boy who presented as non-traumatic coma and was found to have bilateral CVT on MRI. He subsequently underwent endovacular mechanical thrombectomy (EMT) Results: Case Presentation: We report a case of a 17 year old boy who presented as non-traumatic coma. Further imaging revealed extensive cerebral venous sinus thrombosis with hemorrhagic venous infarction in bilateral parietal lobes. Examination revealed a drowsy child. Hemodynamics were within the normal range. However, a detailed neurological examination revealed anisocoric pupils, increased tone in all four extremities and upgoing planters; He was started on Enoxaprin (1mg/kg SC Q12hourly); This was not an easy decision since the patient also had a hemorrhagic conversion in the infarct. There was no significant clinical improvement despite initiation of anticoagulation. A multidisciplinary decision led by neurology, hematology, and critical care decided on an emergent endovascular mechanical thrombectomy. Aspiration thrombectomy in the Superior sagittal sinus was performed and the enoxaparin was later switched to rivoroxaban. The patient showed dramatic clinical improvement. He regained consciousness with restoration of motor function.Conclusions: Endovascular mechanical thrombectomy is a safe therapeutic consideration of failed medical management for bilateral CVT.