Point-of-Care Mastoid Fontanelle Ultrasonography for Diagnosis and Bedside Follow-up of Neonatal Transverse Sinus Thrombosis: A Case Report.
Nazan Neslihan Dogan Kocabıyık, Cagin Huryol, Ecem Esra Erol et al.
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Case in brief
A preterm neonate presented with apnea and later developed focal neurological deficits. Anterior fontanelle ultrasonography was unremarkable, but point-of-care mastoid fontanelle ultrasonography showed markedly reduced venous flow in the right transverse sinus, prompting suspicion of thrombosis. MRI with venography confirmed neonatal cerebral venous sinus thrombosis. During anticoagulant therapy, serial bedside mastoid fontanelle ultrasonography showed thrombus regression, with findings concordant with MRI/MRV.
What made this case unusual
The anterior fontanelle study was unremarkable, whereas mastoid fontanelle ultrasonography detected reduced flow in the affected transverse sinus and also supported bedside follow-up.
Diagnostic / clinical pearl
In a neonate with suspected cerebral venous sinus thrombosis, mastoid fontanelle ultrasonography may complement anterior fontanelle imaging and provide bedside monitoring; MRI with venography confirmed the diagnosis in this case.