Cerebral Venous Sinus Thrombosis Secondary to Pediatric Meningoencephalitis with Temporal Association to Japanese Encephalitis Vaccination: A Case Report
Keywords:
CVST, Infection, Japanese Encephalitis Vaccine, Meningoencephalitis, PediatricAbstract
Introduction: Pediatric meningoencephalitis is a significant cause of acute neurological morbidity and may be complicated by secondary cerebrovascular events such as cerebral venous sinus thrombosis (CVST). The occurrence of neurological symptoms following recent vaccination presents a diagnostic challenge, particularly in distinguishing causal relationships from coincidental associations. Case presentation: A 6-year-old boy presented with fever, recurrent seizures, and altered consciousness. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis suggestive of a viral etiology. Magnetic resonance venography confirmed thrombosis of the left transverse and sigmoid sinuses. A history of Japanese encephalitis vaccination 13 days prior to symptom onset was noted, along with preceding dental symptoms initially raising suspicion of a possible odontogenic source. The patient was managed with antiepileptic therapy, intracranial pressure control, empirical antibiotics, and anticoagulation. Clinical improvement was observed, with full neurological recovery at discharge. Conclusion: This case highlights the importance of considering CVST as a potential complication of pediatric meningoencephalitis and underscores the need for cautious interpretation of temporal associations with vaccination. Early recognition and appropriate multidisciplinary management, including anticoagulation when indicated, are essential to optimize clinical outcomes.
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References
1. Britton PN, Dale RC, Blyth CC, Clark JE, Crawford N, Marshall H, et al. Causes and clinical features of childhood encephalitis: a multicenter, prospective cohort study. Clin Infect Dis. 2020;70(12):2517–2526. doi:10.1093/cid/ciz685. https://doi.org/10.1093/cid/ciz685
2. Venkatesan A. Encephalitis: intersections between infections and autoimmunity. Clin Microbiol Infect. 2025;31(4):529–533. doi:10.1016/j.cmi.2024.11.028. https://doi.org/10.1016/j.cmi.2024.11.028
3. Mishra S, Mallick AK, Mohanty GM, Nayak P. Cerebral venous sinus thrombosis in children: a study from a tertiary care hospital of Eastern India. J Pediatr Neurosci. 2020;15(4):370–374. doi:10.4103/jpn.JPN_133_19. https://doi.org/10.4103/jpn.JPN_133_19
4. Sinha R, Ramji S. Neurovascular disorders in children: an updated practical guide. Transl Pediatr. 2021;10(4):1100–1116. doi:10.21037/tp-20-205. https://doi.org/10.21037/tp-20-205
5. Srivastava KS, Jeswani V, Pal N, Bohra B, Vishwakarma V, Bapat AA, et al. Japanese encephalitis virus: an update on the potential antivirals and vaccines. Vaccines (Basel). 2023;11(4):742. doi:10.3390/vaccines11040742. https://doi.org/10.3390/vaccines11040742
6. Kumar VS, Sivasubramanian S, Padmanabhan P, Anupama CP, Ramesh K, Gunasekaran P. Etiological profile and clinico epidemiological patterns of acute encephalitis syndrome in Tamil Nadu, India. J Glob Infect Dis. 2023;15(2):52–58. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10353646/
7. Satchidanandam V. Japanese encephalitis vaccines. Curr Treat Options Infect Dis. 2020;12(4):375–386. doi:10.1007/s40506-020-00242-5. https://doi.org/10.1007/s40506-020-00242-5
8. Capeding MR, Alberto E, Feser J, Mooney J, Tang Y, Audet SA, et al. Immunogenicity and safety of concurrent or sequential administration of live, attenuated SA 14-14-2 Japanese encephalitis vaccine (CD-JEV) and measles-mumps-rubella vaccine in infants 9–12 months of age in the Philippines: a non-inferiority phase 4 randomized clinical trial. Vaccine X. 2020;6:100074. doi:10.1016/j.jvacx.2020.100074. https://doi.org/10.1016/j.jvacx.2020.100074
9. Zhang C, Liu Y, Luo X, Han L, Shen J. Real-world safety profile of live attenuated Japanese encephalitis vaccine before and after the vaccine administration law. PLoS One. 2025;20(6):e0326257. doi:10.1371/journal.pone.0326257. https://doi.org/10.1371/journal.pone.0326257
10. Hills SL, Soeung SC, Sarath S, Morn C, Dara C, Fischer M, et al. An evaluation of adverse events following an immunization campaign with the live, attenuated SA14-14-2 Japanese encephalitis vaccine in Cambodia. PLoS One. 2022;17(6):e0269480. doi:10.1371/journal.pone.0269480. https://doi.org/10.1371/journal.pone.0269480
11. de Blauw D, Bruning AHL, et al. Incidence of childhood meningoencephalitis in children with a suspected meningoencephalitis in the Netherlands. Pediatr Infect Dis J. 2022;41(4):290–296. doi:10.1097/INF.0000000000003441. https://doi.org/10.1097/INF.0000000000003441
12. Kneen R, Michael BD, Menson E, Mehta B, Easton A, Hemingway C, et al. Management of suspected viral encephalitis in children – Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group national guidelines. J Infect. 2012;64(5):449–477. doi:10.1016/j.jinf.2011.11.013. https://doi.org/10.1016/j.jinf.2011.11.013
13. Faraj LA, Alghamdi KM, Tayyib EM, Asiri AM, Al-Dhahry SA, Alzayer EK, et al. An overview on pediatric meningitis diagnosis and management approach. Int J Pharm Res Allied Sci. 2021;10(4):84–88. doi:10.51847/8fnDhpmWUW. https://doi.org/10.51847/8fnDhpmWUW
14. van de Beek D, Brouwer MC, Koedel U, Wall EC. Community-acquired bacterial meningitis. Lancet. 2021;398(10306):1171–1183. doi:10.1016/S0140-6736(21)00883-7. https://doi.org/10.1016/S0140-6736(21)00883-7
15. Ellul M, Solomon T. Acute encephalitis – diagnosis and management. Clin Med (Lond). 2018;18(2):155–159. doi:10.7861/clinmedicine.18-2-155. https://doi.org/10.7861/clinmedicine.18-2-155
16. Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the art: acute encephalitis. Clin Infect Dis. 2023;77(5):e14–e33. doi:10.1093/cid/ciad306. https://doi.org/10.1093/cid/ciad306
17. Wang X, Zhang L, Chai Y, Wang J, Yu L, Zhou S. Clinical characteristics and outcomes of pediatric cerebral venous sinus thrombosis: an analysis of 30 cases in China. Front Pediatr. 2019;7:364. doi:10.3389/fped.2019.00364. https://doi.org/10.3389/fped.2019.00364
18. Mehta N, Sheth N, Halverson M, Beslow LA, Ichord RN, Loerinc L, et al. Cerebral sinovenous thrombosis in children with acute bacterial intracranial infection. Neurology. 2025;105(8):e214175. doi:10.1212/WNL.0000000000214175. https://doi.org/10.1212/WNL.0000000000214175
19. Sutter PA, Anderson MG, Sahyouni R, Plonsker J, Ravindra VM, Gonda DD, et al. Anticoagulation for the treatment of septic cerebral venous sinus thrombosis in the setting of pediatric sinogenic and otogenic intracranial infections. Neurosurg Focus. 2023;55(4):E8. doi:10.3171/2023.7.FOCUS23374. https://doi.org/10.3171/2023.7.FOCUS23374
20. Craig JR, Cheema AJ, Dunn RT, Vemuri S, Peterson EL. Extrasinus complications from odontogenic sinusitis: a systematic review. Otolaryngol Head Neck Surg. 2022;166(4):623–632. doi:10.1177/01945998211026268. https://doi.org/10.1177/01945998211026268
21. Tumuluri V, Tong JY, Tumuluri K, Selva D. Clinical and radiological characteristics of odontogenic orbital cellulitis. J Ophthalmic Inflamm Infect. 2024;14:48. doi:10.1186/s12348-024-00422-0. https://doi.org/10.1186/s12348-024-00422-0
22. Capecchi M, Abbattista M, Martinelli I. Cerebral venous sinus thrombosis. J Thromb Haemost. 2018;16(10):1918–1931. doi:10.1111/jth.14210. https://doi.org/10.1111/jth.14210
23. Saposnik G, Bushnell C, Coutinho JM, Field TS, Furie KL, Galadanci N, et al. Diagnosis and management of cerebral venous thrombosis: a scientific statement from the American Heart Association. Stroke. 2024;55(3):e77–e90. doi:10.1161/STR.0000000000000456. https://doi.org/10.1161/STR.0000000000000456
24. Sánchez van Kammen M, Male C, Connor P, Monagle P, Coutinho JM, Lensing AWA; EINSTEIN-Jr CVT investigators. Anticoagulant treatment for pediatric infection-related cerebral venous thrombosis. Pediatr Neurol. 2022;128:20–24. doi:10.1016/j.pediatrneurol.2021.12.011. https://doi.org/10.1016/j.pediatrneurol.2021.12.011
25. Sun R, Huang F, Wu W, Yin G, Ding Q, Gu Z, et al. Association of neutrophil to lymphocyte ratio and D-dimer with functional outcome in patients with cerebral venous sinus thrombosis. BMC Neurol. 2023;23:30. doi:10.1186/s12883-022-03030-4. https://doi.org/10.1186/s12883-022-03030-4
26. Wang S, Cheng X, Li J, Li X, Zhu F, Liu P, et al. Comparing the immunogenicity and safety of 3 Japanese encephalitis vaccines in Asia-Pacific area: a systematic review and meta-analysis. Hum Vaccin Immunother. 2015;11(6):1418–1425. doi:10.1080/21645515.2015.1011996. https://doi.org/10.1080/21645515.2015.1011996
27. Liu L, Zhang L, Hu R, Kang G, Yu J, Sun X. An active surveillance study of adverse events following to Japanese encephalitis inactivated vaccine (JE-I) in Jiangsu Province, China, 2024–2025. Expert Rev Vaccines. 2026;25(1). doi:10.1080/14760584.2026.2653748. https://doi.org/10.1080/14760584.2026.2653748
28. Li X, Ma S, Liu X, Jiang L, Zhou J, Xiong Y, et al. Immunogenicity and safety of currently available Japanese encephalitis vaccines: a systematic review. Hum Vaccin Immunother. 2014;10(12):3579–3593. doi:10.4161/21645515.2014.980197. https://doi.org/10.4161/21645515.2014.980197
29. Liu F, Ran Q, Zhang H, Li Z, Chen J. Safety profile of Japanese encephalitis vaccines: a comprehensive analysis of vaccine adverse event reports from 1993 to 2025. Front Public Health. 2025;13:1647485. doi:10.3389/fpubh.2025.1647485. https://doi.org/10.3389/fpubh.2025.1647485
30. Abend NS, Loddenkemper T. Management of pediatric status epilepticus. Curr Treat Options Neurol. 2014;16(7):301. doi:10.1007/s11940-014-0301-x. https://doi.org/10.1007/s11940-014-0301-x
31. Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of Neurology. Eur Stroke J. 2017;2(3):195–221. doi:10.1177/2396987317719364. https://doi.org/10.1177/2396987317719364
32. Monagle P, Cuello CA, Augustine C, Bonduel M, Brandão LR, Capman T, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv. 2018;2(22):3292–3316. doi:10.1182/bloodadvances.2018024786. https://doi.org/10.1182/bloodadvances.2018024786
33. Azzam M, Kawtharany H, Monagle P, Bercovitz RS, Hamarsha Q, Alkhader A, et al. Anticoagulation therapy for venous thromboembolism in the pediatric population: a systematic review and meta-analysis [abstract]. Blood. 2024;144(Suppl 1):1257. Available from: https://ashpublications.org/blood/article/144/Supplement%201/1257/532335/
34. Connor P, Sánchez van Kammen M, Lensing AWA, Chalmers E, Kállay K, Hege K, et al. Safety and efficacy of rivaroxaban in pediatric cerebral venous thrombosis (EINSTEIN-Jr CVT). Blood Adv. 2020;4(24):6250–6258. doi:10.1182/bloodadvances.2020003244. https://doi.org/10.1182/bloodadvances.2020003244
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