Relato de caso: Trombose Venosa Cerebral como provável causa pós-raquianestesia em criança

• DOI: https://doi.org/10.22533/at.ed.00424170712

• Palavras-chave: Raquianestesia; Trombose venosa cerebral; Criança; Herniorrafia.

• Keywords: Spinal anesthesia; Cerebral venous thrombosis; Children; Herniorrhaphy.

• Abstract: Introduction: Cerebral Venous Thrombosis (CVT) is caused by the occlusion of the venous sinuses and cerebral veins by thrombi. In rare cases, especially in children, it can be a serious complication of spinal anesthesia, with headache being the most common initial symptom. Case report: Patient admitted to the emergency room at a hospital institution with a sudden onset of intense headache, nausea, vomiting and abdominal pain that progressed to a reduced level of consciousness, weakness in the lower limbs and episodes of syncope preceded by blurred vision. He reported a previous history of umbilical herniorrhaphy surgery under spinal anesthesia four days before admission. Intravenous hydration, symptomatic treatment, clinical monitoring and additional work-up were requested. The computed tomography of the head revealed a “hyperdense image suggestive of cerebral venous sinus thrombosis”, a diagnosis that was confirmed by computed tomography angiography of the head. Therefore, intravenous enoxaparin was started at a therapeutic dose and investigation for thrombophilia was solicited. The patient improved clinically and radiologically, presenting negative results for thrombophilia testing. He was discharged from the hospital after eight days, without sequelae, with instructions to continue the use of enoxaparin on an outpatient basis and clinical follow-up by the neurology service. Discussion: The loss of cerebrospinal fluid leads to dilation and venous stasis, which, associated with the traction caused by the upright position, and pro-thrombotic risk factors, can lead to CVT. Patients who present with severe headache, which becomes prolonged after spinal anesthesia, without orthostatic characteristics, associated with vomiting and reduced level of consciousness, must undergo neuroimaging exams to exclude complications. Conclusion: Although rare, the case provided an understanding of the importance of early diagnosis and treatment of Cerebral Venous Thrombosis, reflecting a good prognosis for recovery in pediatrics.