A case of first pediatric pseudotumor cerebri syndrome secondary to superior sagittal sinus thrombosis associated with SARS-CoV-2

A case of first pediatricpseudotumor cerebri syndrome secondary to superior sagittal sinus thrombosisassociated with SARS-CoV-2Introduction: Pseudotumor cerebri syndrome(PTCS) is defined as the presence of elevated intracranial pressure in theenvironment of normal brain parenchyma and cerebrospinal fluid. PTCS can occurin pediatric populations and can cause permanent vision loss if left untreated.It is known that SARS-CoV-2  infection predisposes patients to arterial andvenous thromboembolic events. Several reports from the literature suggest thatcerebral venous sinus thrombosis (CVST) may be a direct complication of SARS-CoV-2. We aimed to report a case of PTCSsecondary to superior sagittal sinus thrombosis associated with the firstpediatric SARS-CoV-2 infection.Case: A previously healthy13-year-old boy presented with a 4-day history of headache, tinnutus anddiplopia. His mental status and cranial nerve examination were normal in hisneurological examination at admission, and bilateral papilledema was detectedin fundus examination. SARS-CoV-2 polymerase chain reaction was negative, whileanti-SARS-CoV-2 antibody was positive. Contrast-enhanced brain magneticresonance imaging showed signs of intracranial hypertension and MR venographyshowed superior sagittal sinus thrombosis. The lumbar puncture showed highopening pressure (73 cmH2O). He was treated with lowmolecular weight heparin  and topiramate. Our patient was diagnosedas PTS secondary to CVST associated with SARS-CoV-2 infection.Conclusion:  PTCS secondary to CVST associated with SARS-CoV-2  infection was diagnosed and the child wastreated with oral topiramate and low molecular weight heparin. After treatment,headache and visual functions improved and the child was followed up. Clinicians shouldconsider the risk of acute CVST in SARS-CoV-2 positive patients, especially if neurological symptoms develop. Earlydiagnosis and treatment can prevent vision loss.Keywords: SARS-CoV-2,Pseudotumor cerebri, papilledema, cerebral venous sinus thrombosis,Çocuklardamultisistem inflamatuar sendrom (MIS-C), şiddetli akut solunum sendromukoronavirüs 2 enfeksiyonu ile ilişkili nadir fakat yaşamı tehdit eden birinflamatuar immün yanıttır. Hastaların çoğunda hipotansiyon, şok,gastrointestinal, kardiyovasküler ve mukokutanöz semptomlargörülmüştür. MIS-C’de nörolojik semptomların insidansı, daha az hastadaiyi tanımlanmadıkları ve raporlanmadıkları için artan bir endişekaynağıdır. 8 yaşında erkek çocuk baş ağrısı, ateş, konjonktivit vehiperinflamatuar bulgularla MIS-C tanısı ile hastaneye başvurdu. Başağrısı, kusma ve konjonktivit şikayetleriyle yapılan fundus muayenesindebilateral papilödem saptandı. Psödotümör serebri, MIS-C’nin görme kaybınayol açabilen ve sadece MIS-C’nin standart tedavisi ile çözülemeyen nadir birtezahürüdür.