A rare complication in a child undergoing chemotherapy for Hodgkin lymphoma - multiple cerebral venous sinus thrombosis

Abstract

Introduction. Risk factors for thrombotic events in patients receiving treatment for Hodgkin lymphoma are not well known. Administration of some cytostatic medication, especially via central venous catheter, corticosteroids and hyperlipidemia can present some of them. Case outline. A case of a 15-year-old boy that had been newly diagnosed with Hodgkin lymphoma is presented here. Chemotherapy according to vincristine, etoposide, prednisone, and doxorubicin (OEPA) protocol was introduced a month before headache and vomiting occurred, so subsequently, brain- computer tomography (CT) was performed, and reviled laminar subdural pseudo hemorrhage in the right occipital region. After performing magnet resonance imaging (MRI) venous thrombosis of the posterior part of superior sagittal sinus, right transverses and sigmoid sinus were presented. Low-molecular-weight heparin (LMWH) and anti-edematous therapy was immediately initiated. Two weeks later the patient resumed the second cycle of chemotherapy combined with LMWH, as the previous symptoms of intracranial hypertension resolved. Two years after MRI showed almost complete resolution of finding. The boy was in good clinical condition. Conclusion. Although administration of oral corticosteroids, could be rarely a risk factor per se for cerebral sinus venous thrombosis in HL patients, it remains important treatment option. Adequate and prompt diagnostics and therapy are mandatory in cases of wide intracranial venous thrombosis as prevention of possible intracranial hypertension and even fatal outcome.