LEFT TRANSVERSE VENOUS SINUS THROMBOSIS ASSOCIATED TO PNEUMOCOCCAL MENINGITIS IN CHILDREN – INTUITIVE VS. COGNITIVE DIAGNOSIS

Abstract

Introduction. Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition involving multiple etiologies. Diagnosis of CVT is usually overlooked or delayed due to highly varied symptomatology, modes of onset and neuroimaging signs; furthermore, the same cause cannot be found in more than 15% of the cases, individual result being hard to predict, while the disease can complicate despite anticoagulant treatment. Material and methods. We present a typical case of meningitis that in day 10 of illness associated an uncommon symptomatology suggesting cerebral venous sinus thrombosis (CVST). Results. It should be noted that imaging examination can neither confirm nor exclude a thrombosis. A case whose development worsens progressively and for which there is no imaging exam to support a particular therapeutic conduct hampers the decision-making process for the physician. Discussion. The issue raised focuses on the assumption that anticoagulant medication may be beneficial to the patient or, on the contrary, it may be in the detriment of the physician who is uncertain about the diagnosis, due to subsequent unfavorable development of patient clinical status. Conclusions. That human rational thinking, exercised in years of experience, cannot yet be technologized, let alone replaced by a robot, and the existence of sets of rules for treatment incapable to ever cover the variety of features encountered in practice must always be doubted.

Keywords

• cerebral vein thrombosis
• meningitis
• seizures
• computer-tomography
• diagnosis