FATAL CEREBRAL TRANSVERSE VENOUS THROMBOSIS IN AN ADOLESCENT MALE: A CASE OF DELAYED PRESENTATION.

Introduction/background: Venous sinus thrombosis hypercoagulable states leads to delayed drainage of blood from the brain; consequently, resulting in cerebral oedema, raised intracranial pressure, or stroke. Causes are variable, including severe dehydration, infections, cancers, sinusitis, and brain surgery. The commonest symptoms are headache, seizures, and unconsciousness.

Case report: An 18-year-old male was brought unconscious to us after developing recurrent convulsive seizures the night before. His illness started 6 months ago with recurrent headaches, weight loss, and fatigue in Senegal where he was undergoing Quranic education. He returned to the Gambia, and despite several treatments, including hospitalizations and transfusion of 3 units of whole blood, analgesics, and blood tonics, symptoms persisted, until he convulsed and lost consciousness. There was no other significant past medical history of note. On presentation, he was dehydrated, malnourished, afebrile, mild pallor, anicteric; RR 22 cpm, pulse rate 110 bpm, regular and small volume, BP 113/78 mmHg; unconscious (GCS 3/15); supple neck, conjugate slowly roving eyeballs, positive Doll's eyes test, bilateral pinpoint pupils. Generalized hypotonia and hyporeflexia. The rest of the general examination was unremarkable. His hematological and clinical biochemistry investigations show normal findings. A brain CT scan revealed cerebral oedema, filling defects at the straight sinus, and multiple cerebral haematomas consistent with cerebral venous sinus thrombosis. He was immediately started on heparin but died less than 24 hours later.

Conclusion: Diagnosis requires a Brain CT of MR venography to identify filling defects. This is especially difficult in low-income countries, hence diagnosis is often missed.