単純CT／MRIが有用であった頭部外傷後小児静脈血栓症の１例

抄録

Introduction: Cerebral venous sinus thrombosis following blunt head trauma in children is extremely rare, but potentially fatal with an acute mortality rate of nearly 10%. Symptoms of cerebral sinus thrombosis are variable, ranging from blurry vision and headaches to complete loss of consciousness, making it is difficult to diagnose at an early stage. We describe a unique case of traumatic blunt head injury, which was imaged using nonenhanced computed tomography (CT), T1 and T2–weighted magnetic resonance imaging (MRI) and MR veno­graphy leading to an early diagnosis and treatment of a cerebral sinus thrombosis in a young child.

Case report: A 6–year–old boy presented to our hospital im­mediately following a traffic accident. A CT scan of the head was emergently ordered and revealed an acute epidural hema­toma, bilateral occipital lesions, an occipital bone fracture. Imaging on the following day, revealed no increases in the size of the epidural hematoma or in the amount of gas seen in the right transverse sinus, but a new increased density area was seen in the lesion of the right transverse–sigmoid junc­tion. T1 and T2–weighted MRI showed a hyperintense area and MRV showed the disappearance of the right sigmoid sinus, leading to the diagnosis of a traumatic venous sinus thrombosis. The patient was treated conservatively with symptomatic relief of nausea and cephalgia and without anti­coagulation. Repeat imaging on day 8 found no increase in the size of the cerebral venous sinus thrombus and the patient was discharged to home on day 17.

Conclusion: We report on a rare pediatric case of atraumatic venous sinus thrombosis successfully diagnosed by non­enhanced CT and MRI imaging at an early stage allowing for a reduction of morbidity and overall survival.