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Delayed Onset Bilateral Papilledema in a Young Boy's Eyes after Trauma
1Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
Insights
Cerebral venous sinus thrombosis (CVST) can occur after head trauma, even with delayed symptoms. This case highlights the need for vigilance in diagnosing CVST in children with persistent neurological issues post-injury.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Cerebral venous sinus thrombosis (CVST) is a rare condition, typically affecting young adults.
- Head trauma is an infrequent cause of CVST, accounting for 1-3% of cases.
- Delayed symptom onset in pediatric CVST cases is not well-documented.
Observation:
- A 12-year-old boy presented with delayed, non-specific visual symptoms 11 days post-head trauma.
- Initial physical examination and non-contrast CT scan were unremarkable.
- The patient subsequently experienced seizures, indicating neurological deterioration.
Findings:
- The diagnosis of trauma-related CVST was established, complicated by delayed increased intracranial pressure and bilateral papilledema.
- This case demonstrates a rare presentation of CVST in a pediatric patient following head trauma.
- Negative serial non-contrast cranial CT scans can mask the diagnosis of CVST.
Implications:
- Physicians should maintain a high index of suspicion for CVST in pediatric patients with a history of head trauma and persistent neurological symptoms.
- Increased awareness and consideration of advanced imaging may be necessary for early CVST diagnosis in this population.
- This case underscores the importance of considering CVST in the differential diagnosis of post-traumatic neurological changes in children.
Abstract:
Cerebral venous sinus thrombosis (CVST) is a rare venous thromboembolic disease that affects young adults in their thirties, with a female predilection. Head trauma accounts for only 1-3% of cases among possible etiologies. Here, we present a particular case of trauma-related CVST with delayed-onset symptoms and signs in a young boy. A 12-year-old boy presented to the emergency department with non-specific visual symptoms 11 days after head trauma. Apart from mild-grade disc swelling in the right eye and dyschromatopsia in both eyes, no significant findings were revealed during physical examinations and a non-contrast cranial computed tomography (CT) scan. Unfortunately, the patient suffered multiple seizure attacks the following day. Trauma-related CVST, complicated by delayed-onset increased intracranial pressure, and bilateral papilledema were finally diagnosed. Physicians need increased awareness of a possible CVST diagnosis if a patient with a history of head trauma shows persistent or worsening neurological symptoms despite negative results on serial non-contrast cranial CT scans.
