EXTENSIVE CEREBRAL VENOUS SINUS THROMBOSIS IN A 9-MONTH-OLD INFANT WITH SEVERE DEHYDRATION AND SUSPECTED SEPSIS: A CASE REPORT

Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially severe pediatric cerebrovascular disorder. We report a previously healthy 9-month-old boy admitted with severe dehydration and hypovolemic shock after five days of acute gastroenteritis associated with fever and suspected sepsis. On admission, he was obtunded, hypotonic, poorly reactive, and markedly dehydrated with peripheral hypoperfusion. Laboratory investigations showed severe microcytic anemia (hemoglobin 7.1 g/dL; mean corpuscular volume 59.5 fL), thrombocytopenia, leukocytosis, and elevated inflammatory markers. During hospitalization, he developed status epilepticus. Contrast-enhanced brain computed tomography demonstrated extensive thrombosis of the superior sagittal sinus with extension into the left transverse sinus. Therapeutic anticoagulation with enoxaparin was initiated, followed by oral acenocoumarol. A thrombophilia workup did not reveal a documented congenital prothrombotic disorder. Early follow-up computed tomography showed partial regression but persistent superior sagittal sinus thrombosis. On pediatric hematology recommendation, anticoagulation was continued until July 2026, for approximately 14 months. Later magnetic resonance venography showed favorable evolution without evidence of active thrombosis. This case highlights the multifactorial nature of pediatric CVST and the importance of urgent neuroimaging when neurological deterioration occurs during severe dehydration or systemic inflammatory illness.