Case Report

A 3-years-old boy, treated for non-communicating hydrocephalus, with medium pressure child valve (international standard device), that evolved 30 days after surgery with headache and vomiting without clinical signs, laboratory or radiological evidence of dysfunction of the system or meningitis.

The contrasted tomography revealed a picture suggestive of vascular change in the topography of the transverse and sigmoid sinuses (Fig. 1).

The angiographic investigation, in about 60 days after, showed a extensive venous thrombosis on posterior sagittal sinus, left transverse sinus and jugular vein proximal region, with no signs of congenital malformations and venous circulation incipient side (Fig. 2), without anticoagulant at the moment.

About 20 days after, the boy developed bilateral subdural collections on fronto-parietal regions (Fig. 3) and then underwent to a new surgical procedure, being replaced by high-pressure system shunt and the performance of a third ventriculostomy procedure.

The patient evolved without neurological sequelae, with tomographic improvement of subdural collections in subsequent attendance.

Conclusions

Cerebral Venous Thrombosis is a consequence of the thrombotic material occluding cerebral vessels and venous sinuses, which blocks the cerebral venous return.

The first description was made by Ribes at the beginning of the nineteenth century.

It is an entity that can occur in different clinical syndromes, with acute or chronic course, and has been associated with numerous etiology as Prothrombotic Disease, cancer, autoimmune diseases, arteriovenous malformations, diagnostic and therapeutic procedures, among others.

The mortality is relatively infrequent in the literature (30-50%), although more recent studies have showing 10%.

The most common manifestations of CVT are: headache, papilledema, focal deficits, seizures and impaired consciousness.

The occurrence of cerebral venous thrombosis (CVT) in patients with Atrioventricular junction has been described in the literature, but there aren’t cases described in the international PubMed database, when the search includes cerebral venous thrombosis in patients undergoing ventriculoperitoneal cerebrospinal fluid shunt – VP-CSFS.

However, hypercoagulability states such as disseminated intravascular coagulation may occur as a complication of VP-CSFS, in cases described in the literature.

Concluding, the physiopathology of the condition may be linked to the stretch of tributary veins leading to venous sinuses and consequent thrombosis. This is a hypothesis that should be investigated.

HYDROCEPHALUS