title: Multiple cerebral sinus thromboses complicating meningococcal meningitis: a pediatric case report.
abstract: BACKGROUND
  Cerebral venous sinus thrombosis (CVT) is a rare and potentially life-threatening condition in the pediatric population. The clinical presentation is frequently nonspecific; thus diagnosis is often delayed or missed.
  
  
  METHODS
  A previously healthy 8 month-old boy was diagnosed with meningococcal meningitis. At hospital admission, an urgent non contrast-enhanced computed tomography (CT) of the head and neck was performed with normal results. Ceftriaxone was promptly started and the clinical condition of the patient improved. However, on the 7th day of hospitalization, the child suddenly manifested irritability and lethargy. An urgent contrast-enhanced CT of the head and neck was immediately performed, revealing thrombosis of the superior sagittal, transverse and rectus sinuses. A thrombophilic evaluation was performed, revealing hyperhomocysteinemia and methylenetetrahydrofolate reductase (MTHFR) variants (C677T and A1298C).
  
  
  CONCLUSIONS
  The causes of CVT may be categorized into three main groups: hypercoagulable states, conditions causing blood flow disturbances, and all causes of inflammation or infection. In this case report, we observed more than one risk factor that predisposed the patient to CVT. Consequently, even if a causative factor is detected, a thrombophilic blood evaluation should be performed. In fact, in case of a prothrombotic condition, the patient's family should be advised that prompt administration of anticoagulant is necessary in the event of situations that could lead to thrombosis. Finally, CVT may be considered a possible complication of infection even when recent imaging results are normal. A prompt CVT diagnosis is required to obtain a good outcome. Delayed diagnosis is mainly due to the rarity of the disease and physicians' unawareness of this type of complication.
authors.affiliation: Department of Pediatrics, Pediatric and Infectious Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. elena.bozzola@opbg.net.
authors.forename: Elena
authors.initials: E
authors.lastname: Bozzola
authors.forename: Mauro
authors.initials: M
authors.lastname: Bozzola
authors.forename: Giovanna Stefania
authors.initials: GS
authors.lastname: Colafati
authors.forename: Valeria
authors.initials: V
authors.lastname: Calcaterra
authors.forename: Annachiara
authors.initials: A
authors.lastname: Vittucci
authors.forename: Matteo
authors.initials: M
authors.lastname: Luciani
authors.forename: Alberto
authors.initials: A
authors.lastname: Villani
mesh_terms: D006801:Humans; D020138:Hyperhomocysteinemia / Q000175:diagnosis* / Q000235:genetics; D007223:Infant; D008297:Male; D008585:Meningitis, Meningococcal / Q000150:complications*; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D009154:Mutation; D012851:Sinus Thrombosis, Intracranial / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D042965:Methylenetetrahydrofolate Reductase (NADPH2)