Pediatric Cerebral Venous Sinus Thrombosis as a Rare Vascular Disorder in Toddler: A First Case Report in Cambodia

Cerebral venous sinus thrombosis (CVST) in children is a rare vascular disorder that presents with nonspecific symptoms leading to a delay in diagnosis and treatment. The estimated annual incidence is up to 7 cases per million among children. To our knowledge, no case was previously reported in Cambodia; therefore, we report our first case to share with our colleagues. A 2-year-old boy of Cambodian origin presented with a 2-day history of fever, 3 episodes of partial seizures expressing right hand tonic and jerking without vomiting. Past medical history was not remarkable. On physical examination, non-toxic appearance and fully alert with normal neurologic examination were observed with low grade fever 38ºC. Initial blood analyses showed a high level of D-dimer to 1735 mg/L, a hemoglobin level of 11.1 g/dL and an increased platelet count of 737 x109/L, white blood cell count of 20×10⁹/L, neutrophils of 12 x109/L and lymphocytes of 6 x109/L. Activated partial thromboplastin time (APTT), prothrombin time (PT), and International normalized ratio (INR) were 41.4, 11 seconds, and 0.84, respectively. Cerebral computed tomography (CT) scan with contrast shown as 5 mm CVST. This toddler was treated with oral Warfarin (direct oral anticoagulant), and the progression over the past 6-month monitoring showed normal neurological development and normal milestones for age whereas laboratory profiles showed varying levels of D-dimer. This case gives insight into one of the many presentations in hopes of early detection and a good outcome.