Superior Sagittal Sinus Thrombosis in a 44-Day-Old Preterm Infant. A Case Report

Introduction Superior sagittal sinus thrombosis (SSST) in neonates and young children is a rare but acute and severe condition, with an incidence of approximately 0.6-1 cases per 100,000 children per year [1,2,3]. Infections, dehydration, coagulation disorders, or prematurity are the key risk factors [1,2]. Early diagnosis improves prognosis, which ranges from full recovery to severe neurological impairment [3]. Case Presentation A newborn boy was born through C-section at 27th gestation week with respiratory failure and weighing 1010 g. APGAR 6/8 p. Bevodic period – 5 days. There were no infection signs. Before delivery the mother received antibiotics for prophylaxis and dexamethasone to promote fetal lung maturation. After treatment in NICU with nCPAP therapy, he remained stable, oxygen demand decreased and weight increased. On day 44, his condition worsened: inconsolable crying, lethargy, hypotonia, tachycardia and a tonic-atypical seizure (treated with phenobarbital) presented. Blood tests revealed compensated metabolic acidosis, increased lactates, hyperglycemia, and anemia (HGB 66 g/L). CRP was normal, while urinalysis showed glycosuria and proteinuria. He was intubated, mechanically ventilated, and received 2 erythrocyte transfusions. Suspected infection prompted antibiotics, which were stopped after 3 days when no sepsis or infection was found. Head ultrasound revealed possible subarachnoid bleeding; CSF showed erythrocytes. Coagulation tests indicated elevated APTT (45.4 s), PT (47.1 s), D-dimers (14.61 mg/L), and low fibrinogen (1.76 g/L). SSST was confirmed by doppler neurosonogram, MRA, and neurosurgeons, showing thrombosis of the sinus and ischemic-hemorrhagic foci with encephalomalacic cysts. After 90 days in the hospital, he was discharged but remains severely disabled. Discussion Treatment of SSST in preterm neonates is supportive; the use of anticoagulation is less straightforward than in more mature patients, and strategies focus on risk factor reduction and avoidance of complications. [2] Conclusions This case highlights the importance of early detection of neurological impairments through MRA and also shows that currently exact causes of SSST remain a mystery to be solved in the future.