Dados do Trabalho

Título

Cerebral Venous Thrombosis (CVT) and its interface with arboviroses

RESUMO

Case presentation: A 50-year-old, female, previously healthy sought medical attention due to progressive, squeezing, diffuse headache associated with persistent fever (38°C), arthralgia and myalgia. Given the suspicion of arbovirus, the patient was transferred to a specialized service in Fortaleza. The admission exams revealed platelets of 20.000 mm³, positive PCR for dengue and positive IgM and negative IgG serology. However, during hospitalization, headache intensity worsened, associated with nausea, vomiting, visual blurring and unprecedented tonic-clonic seizures in 4 limbs (post-ictal lasting 30 minutes). Due to clinical worsening, underwent Cranial Resonance and Angioresonance (arterial and venous phases) which revealed venous thrombosis in the transverse sinus and left sigmoid sinus. Absence of changes in the electroencephalogram, lumbar puncture with opening pressure of 25 cmH2O, 10 cells (90% of lymphocytes), no changes in glucose, increase in proteins: 60 mg/dL. It is useful to point out that on this occasion the platelets were 175.000 mm³. Hematological and rheumatological examinations were normal. It was decided to start anticoagulation with low-molecular-weight heparin and later start warfarin 5 mg/day. The patient was discharged without complaints, with oral anticoagulation and follow-up at the CVT outpatient clinic. Discussion: Cerebral venous thrombosis (CVT) is a rare and often underdiagnosed condition. It presents with a wide spectrum of signals and with high variability. Headache is present in most cases. The presence of papilledema, vomiting, blurred vision, alteration of the VI cranial nerve, diplopia, focal deficits, seizures and changes in consciousness are highlighted. Hematological and rheumatological exams as well as the study of vessels with angioresonance are essential for the diagnosis. In this approach it is necessary to be attentive to the interface of arboviruses, an example of dengue, with its repercussions on the Central Nervous System in order to better understand the behavior of the disease. CVT is an uncommon complication in dengue. Final comments: It is essential to be aware of the alarm signals (red flags) as a form of suspected secondary causes of headache. In this context cerebral venous thrombosis constitutes an important differential diagnosis, especially in women with persistent headache in the context of arboviroses.

Palavras Chave

Cerebral Venous Thrombosis; arboviroses