Pediatric Posttraumatic Cerebral Venous Sinus Thrombosis: Successful Resolution With Rivaroxaban

Cerebral venous sinus thrombosis (CVST) is rare in children (0.5%-1.0% of pediatric strokes) and uncommonly associated with closed traumatic brain injury. A 7-year-old girl presented with neurological symptoms following a mild closed craniocerebral injury. Early CT imaging revealed subtle findings that were initially overlooked, leading to delayed diagnosis. Subsequent magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) confirmed the diagnosis of CVST. The patient was successfully treated with enoxaparin bridging followed by rivaroxaban, achieving complete thrombus resolution without bleeding complications. This case highlights the diagnostic challenge of posttraumatic CVST in children, where initial imaging signs may be overlooked. It underscores the importance of vigilant imaging interpretation in pediatric brain trauma with persistent symptoms and demonstrates the efficacy and safety of novel oral anticoagulants (NOACs), specifically rivaroxaban, as a therapeutic option in this population.