CASE REPORT

Utilization of modified digital subtraction angiography in a child with cerebral venous sinus thrombosis presenting with autism spectrum disorder symptoms: A novel approach

Ardianto Pramono , Ristaniah Soetikno, Achmad Hussein Sundawa Kartamihardja, Tinni Trihartini Maskoen, Terawan Agus Putranto, Erwin Setiawan

Ardianto Pramono
Department of Radiology, Universitas Padjajaran RSPAD Gatot Soebroto, Department of Interventional Radiology. Email: ardianto@rspadgs.net

Ristaniah Soetikno
Department of Radiology, Universitas Padjajaran

Achmad Hussein Sundawa Kartamihardja
Department of Radiology, Universitas Padjajaran

Tinni Trihartini Maskoen
Department of Radiology, Universitas Padjajaran

Terawan Agus Putranto
RSPAD Gatot Soebroto. Department of Interventional Radiology

Erwin Setiawan
Department of Radiology, Universitas Padjajaran RSPAD Gatot Soebroto, Department of Interventional Radiology
Online First: April 01, 2019 | Cite this Article
Pramono, A., Soetikno, R., Kartamihardja, A., Maskoen, T., Putranto, T., Setiawan, E. 2019. Utilization of modified digital subtraction angiography in a child with cerebral venous sinus thrombosis presenting with autism spectrum disorder symptoms: A novel approach. Bali Medical Journal 8(1): 322-327. DOI:10.15562/bmj.v8i1.1466


Background: The limited number of case reports about Cerebral Venous Sinus Thrombosis (CVST), especially in the pediatric population who also present with Autism Spectrum Disorders (ASD) symptoms, prompted the authors to be the pioneer in reporting of pediatric CVST with ASD symptoms case in Indonesia. In this study, we would like to report a case of an 8-year-old patient with ASD who was diagnosed with CVST after undergoing Magnetic Resonance Imaging (MRI) examination. After the diagnosis was established, the patient underwent a modified Digital Subtraction Angiography (DSA) method, which was later termed as Intra Arterial Heparin Flushing (IAHF) as its treatment option.

Case presentation: An 8-year-old-boy was brought by his parents to Gatot Soebroto Hospital with speech and communication problems, and also cognitive and behavioral problems such as the inability to count, read words, follow orders and maintain emotional stability. After a thorough standard examination by the attending physician, further examination using Magnetic Resonance Imaging with MR perfusion was suggested to establish a diagnosis. The imaging results showed a decrease in blood flow in the transverse sinus and straight sinus, and also in the internal jugular vein. The patient was diagnosed with CVST. The patient underwent anticoagulation therapy, which was administered through a modified DSA method, which was later termed as IAHF procedure, to increase the cerebral blood flow.

Conclusion: After the patient underwent the IAHF procedure, good clinical outcomes were immediately seen, even at six months follow up. The parents reported that there were improvements in the patient’s cognitive and behavioral status.

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