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Updated: Jun 3, 2026
Establishment of a Modified Ferric Chloride-Induced Superior Sagittal Sinus Thrombosis
Published on: December 30, 2025
A rare complication in a child undergoing chemotherapy for acute lymphoblastic leukemia: superior sagittal sinus
Ting-Yao Wang1, Hsiu-Ju Yen, Giun-Yi Hung
1Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Insights
A rare thrombotic complication, superior sagittal sinus thrombosis, occurred in a child undergoing acute lymphoblastic leukemia chemotherapy. Prompt treatment with low-molecular weight heparin (LMWH) led to neurological recovery and allowed chemotherapy continuation.
Area of Science:
- Pediatric Oncology
- Neurology
- Hematology
Background:
- Acute lymphoblastic leukemia (ALL) treatment involves intensive chemotherapy regimens.
- High-risk ALL patients may experience severe complications during treatment.
- Chemotherapy agents, including corticosteroids and l-asparaginase, can induce hypercoagulable states.
Observation:
- A 4-year-old boy with high-risk ALL developed generalized tonic-clonic seizures and status epilepticus during reinduction chemotherapy.
- Brain MRI revealed superior sagittal sinus and cerebral venous thrombosis.
- The patient presented with left hemiparesis following the thrombotic event.
Findings:
- Treatment with low-molecular weight heparin (LMWH) rapidly improved left hemiparesis within 1 week.
- The patient achieved full ambulation 3 weeks after LMWH initiation.
- Subsequent chemotherapy cycles were completed without complications under LMWH therapy.
Implications:
- This case highlights the significant correlation between l-asparaginase/corticosteroid combination therapy and superior sagittal sinus thrombosis (SST) in pediatric ALL.
- Early recognition and prompt anticoagulation with LMWH are crucial for managing SST and preventing long-term neurological sequelae.
- Vigilant monitoring for thrombotic events in pediatric cancer patients receiving specific chemotherapeutic agents is essential.
Abstract:
We report the case of a 4-year-old boy with acute lymphoblastic leukemia in high-risk group who suffered from generalized tonic-colonic seizure evolving into status epilepticus, and subsequent left hemiparesis during his first reinduction chemotherapy, consisting of dexamethasone, vincristine, l-asparaginase, and epirubicin. Superior sagittal sinus and cerebral venous thrombosis, predominantly in right side, were proved by brain magnetic resonance imaging. After aggressive treatment with low-molecular weight heparin (LMWH), left hemiparesis improved in 1 week. And he was fully ambulatory 3 weeks later. The second cycle of reinduction chemotherapy was conducted smoothly with the concomitant use of LMWH. This case illustrates the strong correlation of the rare thrombotic complication, superior sagittal sinus thrombosis, and hypercoagulable status secondary to combination use of l-asparaginase and corticosteroid. Early and vigilant recognition of superior sagittal sinus thrombosis and prompt anticoagulation with LMWH may prevent further neurological damage.
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