Cerebral Venous Sinus Thrombosis in Pediatric Cancer Patients

Abstract

Cerebral venous sinus thrombosis (CVST) is an uncommon but recognized complication of treatment for leukemia. Our goal was to determine the long-term neurocognitive outcomes in childhood cancer survivors who had CVST during therapy. Nine patients were identified from an institutional database. All had experienced CVST in the setting of L-asparaginase therapy in combination with other chemotherapeutic agents. Four patients completed neuropsychological evaluation. Their neurological examinations were normal. Neuropsychological testing showed that the participants performed well, with average to above-average scores on cognitive and behavioral testing. Three exhibited difficulties on a visual-motor integration task and 1 had difficulty with fine-motor dexterity, nonverbal memory, emotional control, shifting attention, and anxiety. Overall, by patient and parent report, the survivors had few problems. CVST is a known complication associated with treatment for leukemia and non-Hodgkin lymphoma, most commonly observed if asparaginase is used in combination with other chemotherapeutic agents. Although subtle difficulties were noted in survivors on neuropsychological testing, survivors themselves were not aware of the deficits. Further evaluation of leukemia survivors with a history of CVST is needed to assess for deficits and to understand whether further intervention is necessary.

Neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia treated on contemporary treatment protocols: A systematic review

“…(Von der Weid,2001; Langer et al,2002; Hill et al,2004; Spiegler et al,2006; Mahone et al,2007; Aukema et al,2009; Kadan-Lottick et al,2009; Kadan-Lottick et al,2010; Robinson et al,2010; Daams et al,2012; Krawczuk-Rybak et al,2012; Edelmann et al,2013; Genschaft et al,2013; Krull et al,2013; Lewis et al,2013; Ross et al,2013; Schuitema et al,2013; Edelmann et al,2014; Elalfy et al,2014) There were only 4 longitudinal studies that evaluated survivors’ neurocognitive changes from active treatment to post-treatment survivorship phase. (Kingma et al,2001; Harila et al,2009; Halsey et al,2011; Lewis et al,2013) Most studies focused on a pure sample of survivors who received chemotherapy-only treatment protocols while others included separate populations of ALL survivors who received CRT(Kingma et al,2001; Von der Weid,2001; Langer et al,2002; Spiegler et al,2006; Harila et al,2009; Kadan-Lottick et al,2010; Halsey et al,2011; Krull et al,2011; Daams et al,2012; Krull et al,2013; Schuitema et al,2013; Edelmann et al,2014) or patients of other cancer types.…”

“…(Aukema et al,2009; Kadan-Lottick et al,2010) The majority of the included studies had sample sizes between 10 to 50 subjects,(Kingma et al,2001; Langer et al,2002; Hill et al,2004; Mahone et al,2007; Aukema et al,2009; Harila et al,2009; Daams et al,2012; Krawczuk-Rybak et al,2012; Edelmann et al,2013; Genschaft et al,2013; Schuitema et al,2013; Edelmann et al,2014) with the exception of 4 studies with a larger cohort of more than 100 subjects(Von der Weid,2001; Kadan-Lottick et al,2010; Halsey et al,2011; Krull et al,2013) and 3 studies with less than 10 subjects. (Lewis et al,2012; Lewis et al,2013; Ross et al,2013) Most the studies reported survivors’ mean duration of time since diagnosis, which ranged between 5 and 22 years. Eighteen studies included a population of non-cancer controls or a normative healthy sample for comparative purposes.…”

“…(Kingma et al,2001; Von der Weid,2001; Langer et al,2002; Hill et al,2004; Spiegler et al,2006; Mahone et al,2007; Aukema et al,2009; Harila et al,2009; Kadan-Lottick et al,2009; Kadan-Lottick et al,2010; Robinson et al,2010; Halsey et al,2011; Daams et al,2012; Krawczuk-Rybak et al,2012; Lewis et al,2012; Edelmann et al,2013; Genschaft et al,2013; Krull et al,2013; Lewis et al,2013; Ross et al,2013; Schuitema et al,2013; Edelmann et al,2014; Elalfy et al,2014) Commonly utilized neurocognitive batteries were the Amsterdam Neuropsychological Test(De Sonneville,1999), an adult or child version of the Wechsler Intelligence Scale(Wechsler,1997), Delis–Kaplan Executive Function System(Delis et al,2001) and Woodcock Johnson Tests of Achievement(Woodcock et al,2001). …”

Endovascular thrombolysis for pediatric cerebral sinus venous thrombosis with tissue plasminogen activator and abciximab

“…All patients had previously been treated with l-asparaginase. 19 Each patient's CSVT was treated with lowmolecular-weight heparin. Of the 4 patients who were available for long-term follow-up, all had normal or nearnormal neuropsychological outcomes.…”

Supportive Care in Pediatric Cancer: The Road to Prevention of Thrombosis

“…Very recently, Ross et al published the results of their study about long-term neurological outcomes after a median follow-up of 8 years (range 5-10 years). 34 Nine of 200 pediatric patients developed sinovenous thrombosis after treatment with asparaginase for ALL or NHL. Four patients underwent neurological examination and neuropsychological testing.…”