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      Trombosis venosa cerebral como complicación de una otitis media aguda Translated title: Cerebral venous thrombosis as a complication of acute otitis media

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          Abstract

          Resumen La trombosis venosa cerebral es una enfermedad poco frecuente y de carácter excepcional. Se trata de una patología probablemente infradiagnosticada y debería incluirse siempre en el diagnóstico diferencial de la hipertensión intracraneal con focalidad neurológica o convulsiones, sobre todo si existen factores de riesgo conocidos. Las imágenes radiológicas son imprescindibles para su diagnóstico. Presentamos el caso de un paciente de 5 años con estrabismo convergente del ojo derecho de 3 días de evolución, en el contexto de otitis medias repetidas del oído derecho parcialmente tratadas con antibioterapia. Exploración patológica donde destacaba paresia del VI par derecho y un tímpano homolateral hiperémico en la otoscopia. Los exámenes complementarios fueron normales, salvo aumento del dímero-D. Las imágenes radiológicas obtenidas con resonancia magnética cerebral en fase venosa confirmaron la sospecha diagnóstica, pautándose anticoagulación, con evolución favorable.

          Translated abstract

          Abstract Cerebral venous thrombosis is a rare and exceptional disease. It is a pathology probably underdiagnosed and it should always be included in the differential diagnosis of intracranial hypertension with neurological focality and/or convulsions, especially if there are known risk factors. Radiological images are essential for diagnosis. We present the case of a 5-year-old patient with convergent right eye strabismus of 3 days evolution, in the context of repeated ear otitis partially treated with antibiotherapy. Pathological examination highlighting VI right paresis and a hyperemic homolateral eardrum in otoscopy was found. Complementary tests were normal, except for elevation of the D-dimer. Regarding the radiological images obtained with cerebral magnetic resonance with venous-phase, was confirmed, and had a favourable evolution after receiving prescribed anticoagulant treatment.

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          Most cited references8

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          European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology

          Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological Societies in 2010. We aimed to update the previous European Federation of Neurological Societies guidelines using a clearer and evidence-based methodology.
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            Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young.

            The purpose of this statement is to review the literature on childhood stroke and to provide recommendations for optimal diagnosis and treatment. This statement is intended for physicians who are responsible for diagnosing and treating infants, children, and adolescents with cerebrovascular disease. The Writing Group members were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee. The panel included members with several different areas of expertise. Each of the panel's recommendations was weighted by applying the American Heart Association Stroke Council's Levels of Evidence grading algorithm. After being reviewed by panel members, the manuscript was reviewed by 4 expert peer reviewers and by members of the Stroke Council Leadership Committee and was approved by the American Heart Association Science Advisory and Coordinating Committee. We anticipate that this statement will need to be updated in 4 years. Evidence-based recommendations are provided for the prevention of ischemic stroke caused by sickle cell disease, moyamoya disease, cervicocephalic arterial dissection, and cardiogenic embolism. Recommendations on the evaluation and management of hemorrhagic stroke also are provided. Protocols for dosing of heparin and warfarin in children are suggested. Also included are recommendations on the evaluation and management of perinatal stroke and cerebral sinovenous thrombosis in children.
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              Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

              Neonates and children differ from adults in physiology, pharmacologic responses to drugs, epidemiology, and long-term consequences of thrombosis. This guideline addresses optimal strategies for the management of thrombosis in neonates and children. The methods of this guideline follow those described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. We suggest that where possible, pediatric hematologists with experience in thromboembolism manage pediatric patients with thromboembolism (Grade 2C). When this is not possible, we suggest a combination of a neonatologist/pediatrician and adult hematologist supported by consultation with an experienced pediatric hematologist (Grade 2C). We suggest that therapeutic unfractionated heparin in children is titrated to achieve a target anti-Xa range of 0.35 to 0.7 units/mL or an activated partial thromboplastin time range that correlates to this anti-Xa range or to a protamine titration range of 0.2 to 0.4 units/mL (Grade 2C). For neonates and children receiving either daily or bid therapeutic low-molecular-weight heparin, we suggest that the drug be monitored to a target range of 0.5 to 1.0 units/mL in a sample taken 4 to 6 h after subcutaneous injection or, alternatively, 0.5 to 0.8 units/mL in a sample taken 2 to 6 h after subcutaneous injection (Grade 2C). The evidence supporting most recommendations for antithrombotic therapy in neonates and children remains weak. Studies addressing appropriate drug target ranges and monitoring requirements are urgently required in addition to site- and clinical situation-specific thrombosis management strategies.
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                Author and article information

                Journal
                pap
                Pediatría Atención Primaria
                Rev Pediatr Aten Primaria
                Asociación Española de Pediatría de Atención Primaria (Madrid, Madrid, Spain )
                1139-7632
                December 2020
                : 22
                : 88
                : e203-e206
                Affiliations
                [2] Castellón orgnameHospital General de Castellón orgdiv1Servicio de Pediatría España
                [3] Castellón orgnameHospital General de Castellón orgdiv1Servicio de Radiología España
                [1] Castellón orgnameHospital General de Castellón España
                Article
                S1139-76322020000500013 S1139-7632(20)02208800013
                bc5ef6e2-52fe-472c-9bab-77f9e86f1478

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 8, Pages: 0
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                SciELO Spain

                Categories
                Notas Clínicas

                Resonancia magnética,Trombosis venosa cerebral,Anticoagulation,Cerebral venous thrombosis,MRI,Risk factors,Anticoagulación,Factores de riesgo

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