Relationship between Herpes Simplex Virus Type 1 and Extensive Cerebral Sinovenous Thrombosis in a Child with Inherited Hypercoagulable States

Cerebral sinovenous thrombosis (CSVT) is a rare, but potentially serious condition among children which requires a multidisciplinary team approach. Clinical manifestations of CSVT include: headache, vomiting, photophobia, blurred vision, focal or generalized seizures, motor deficits, altered mental status and coma. Objective: Exposure clinical data, laboratory and management in cerebral venous thrombosis in childrena clinical case report. Material and methods. We present a case of 14 months old boy, admitted in ICU National Institute for Infectious diseases "Prof. Matei Bals" for: fever, vomiting,focal and generalized seizures, right hemiparesis and coma. The child was diagnosed with acute herpetic gingivostomatitis one week before onset of neurological symptoms. MRI brain and angiography revealed extensive thrombosis of the straight, transverse and occipital venous sinuses, bilateral thalamic infarction and left haemorrhagic transformation with intraventricular hemorrhage and univentricular obstructive hydrocephalus. Thrombophilic screening was performed and a heterozygous mutations genes of C677T MTHFR and 4G/5G PAI was detected. He was treated with low molecular weight heparin (enoxaparine) followed by oral anticoagulant (acenocumarol) with good clinical outcome and complete neurological recovery. Conclusions: CSVT in children can be fully reversible with early diagnosis and a prompt management. Brain MRI with angio MRI remains the gold standard for diagnosing CSVT.Thrombofilic screening should be considered in any child with stroke history and CSVT. Herpes simplex virus associated infections may precipitate thrombosis in individuals with inherited or acquired hypercoagulable states