Septic cerebral thrombosis in neonates: A case report and review of the literature

Abstract

Introduction: Septic dural-sinus thrombosis is rare; it is one of the most misdiagnosed conditions of our time. It is often associated with a high level of mortality. Especially in neonates who have an underdeveloped immune system and haphazard clinical manifestation. Septic sinus thrombosis frequently involves cavernous sinuses. The superior sagittal sinuses’ involvement is exceptional as it is often associated with a fatal outcome. Studies demonstrate that heparin therapy in sagittal sinus septic thrombosis is unnecessary and that the focus of treatment shall be intravenous antibiotics and early surgical drainage of purulent collections who can be a source of widespread infections. Case Report: We report the case of a three months old boy, without pathological history, admitted in the intensive care unit (ICU) for febrile convulsion resistant to first line therapy. Cerebrospinal fluid analysis results were in favor of pneumococcus pathogens. Cerebral computed tomography (CT) has shown a superior longitudinal sinus thrombophlebitis complicating an encephalitis, with multiple venous infarcts. After which antibiotherapy was changed and anticoagulation added. Six days later, the sedation was stopped to evaluate the neurological state. The patient has shown a persistence of the coma state. After a multidisciplinary discussion, a transcranial Doppler was realized only to confirm the brain death state. The evolution was marked by the death of the patient after three days. Conclusion: In general, cerebral venous thrombosis (CVT) is a disease with complex clinical manifestations, atypical in many patients. If an alteration of consciousness is the main symptom in a CVT patient, the prognosis can be bleak. Most patients with CVT have a good prognosis after early anticoagulant and antibiotherapy. Since cerebral hernia is the most common cause of death in CVT, intensive care should be given special attention to the detection and treatment of focal lesions occupying space.