Issue 1/2023
Rodopska1, E., Bozhinova1, V., Alexandrova1,2, I., Assenova1,2, A., Tomov1, V.,
Kesikov4, G., Topalov2,3, N.
1 Clinic of Nervous Diseases for Children, University Hospital „St. Naum
2 Department of Neurology, Faculty of Medicine, Medical University – Sofia
3 Department of Imaging Diagnostics, University Hospital „St. Naum
4 UMBALNP „St. Naum
Cerebral venous thrombosis (MVT) is a rare disease in childhood with a multifactorial etiology and a variable clinical picture, but with serious neurological consequences and significant mortality. The clinical picture depends on the location and degree of thrombosis, the age of the patients and the presence of underlying diseases. The diagnosis of MBT is confirmed by neuroimaging: CT venography and MRI venography. The article presents two clinical cases of children with cerebral venous thrombosis, diagnosed at the Hospital „St. Naum.
The first case was in an 11-year-old girl with idiopathic generalized epilepsy and evidence of thrombophilia – a mutation in the plasminogen activator inhibitor (PAI-1), a homozygous carrier 4G/4G and a mutation in methylene tetrahydrofolate reductase (CTHgo-7TFR-77FR T/T. The patient was hospitalized in MHAT „St. Naum ”with symptoms characteristic of intracranial hypertension – headache, vomiting, diplopia and ophthalmoscopy data for congestive papillae with a prominence of about 1.5 D. Magnetic resonance imaging (MRI) of the brain shows subacute thrombosis of the upper sagittal sinus and cortical veins on cerebral convexity bilaterally. The child underwent anti-edema and anticoagulant therapy, taking into account the normalization of neurological status and fundus. In the performed control MRI of the brain after about 1.5 months, restored blood flow in the dural sinuses and cerebral veins was visualized. The second case is a 6-year-old boy, in which on the background of purulent otitis symptoms of increased intracranial pressure – headache accompanied by a single vomiting, and a bilateral lesion of n. abducens. Computed tomography (CT) scans show a normal image of the brain parenchyma with evidence of mastoiditis. The case was initially discussed as idiopathic intracranial hypertension (IIH) until an MRI of the brain was performed, which showed thrombosis of the right transverse and sigmoid sinus and the right jugular bulb. Appropriate anti-edema and anticoagulant therapy was started, and 3 months after the initial manifestation, complete recovery of the volume of movement of the eyeballs was reported with partial recanalization of the thrombosed areas. Timely diagnosis and differentiation of IBD from other neurological diseases, as well as the initiation of adequate therapy, is crucial for the prognosis.
Address for correspondence:
Е. Rodopska
Clinic of Nervous Diseases for Children, University Hospital, St. Naum”- Sofia Dianabad,
1113, Sofia, Bulgaria