Cavernous Sinus Thrombosis in Children

Ali, Shahna; Ahmed, Sohail

doi:10.1093/tropej/38.4.194

Cited by 14 publications

(7 citation statements)

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“…Jugular veins are involved in 14%. Cavernous sinus thrombosis has been reported in children from Thailand [82] and India [83], but rarely reported in North American or European series.…”

Section: Cerebral Vtes In Children: Strokementioning

confidence: 99%

Venous thrombosis in children

Chan

deVeber

Monagle

et al. 2003

Journal of Thrombosis and Haemostasis

169

126

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Summary. Venous thromboembolic (VTE) events are being increasingly diagnosed in systemic and cerebral vessels in children. Systemic VTE are increasing in children as a result of therapeutic advances and improved clinical acumen in primary illnesses that previously caused mortality. The epidemiology of systemic VTE has been studied in international registries. In children older than 3 months, teenagers are the largest group developing VTE. The most common etiologic factor is the presence of central venous lines. Clinical studies have determined the most sensitive diagnostic method for diagnosing upper system VTE are ultrasound for jugular venous thrombosis and venography for intrathoracic vessels. However, the most sensitive diagnostic methods for lower system VTE and pulmonary embolism (PE) have not been established. Treatment studies for VTE consist of inadequately powered randomized controlled trials or prospective cohort studies. The long‐term outcome of systemic VTE, post‐thrombotic syndrome, has been reported in children. Cerebral sinovenous thrombosis (CSVT) is becoming increasingly diagnosed in children due to the recognition of the associated subtle clinical symptoms and improved cerebrovascular imaging. The etiology of CSVT includes thrombophilia, head and neck infections, and systemic illness. Estimates of the incidence and outcome of childhood CSVT have recently become available through the Canadian Pediatric Ischaemic Stroke Registry. Clinical studies have not yet been carried out in children to determine the best method of diagnosis or treatment. There have only been case‐series studies carried out in the treatment of CSVT. Properly designed clinical trials are urgently required in children with systemic VTE/PE and CSVT to define the best methods of diagnosis, treatment and long‐term management.

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“…Jugular veins are involved in 14%. Cavernous sinus thrombosis has been reported in children from Thailand [82] and India [83], but rarely reported in North American or European series.…”

Section: Cerebral Vtes In Children: Strokementioning

confidence: 99%

Venous thrombosis in children

Chan

deVeber

Monagle

et al. 2003

Journal of Thrombosis and Haemostasis

169

126

View full text Add to dashboard Cite

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“…2 Staphylococcus aureus is the most frequently cultured organism in these infections (70 per cent), followed by Streptococcus species (20 per cent). 1,2,7,9,13 In the early antibiotic era, paranasal sinusitis was responsible for up to 30 per cent of cases of septic CST. 1 Although septic CST is now infrequently documented, contemporary reports suggest that a greater proportion of CST is due to sinusitis, and it is possible that this has become the most prevalent aetiology as a result of a disproportionately greater reduction in complicated facial infections.…”

Section: Aetiologymentioning

confidence: 99%

“…1 Furthermore, in a recent review of 14 paediatric cases of septic CST from a single centre, 11 (79 per cent) died from this complication in spite of parental antibiotic treatment. 9 Consequently, emphasis must be placed on instituting high dose parental antibiotics at the earliest suspicion of this diagnosis, 4 and empiric antibiotic regimens should be based on the pathogens implicated at the primary source of infection. For most aetiologies, a third generation cephalosporin, metronidazole and an anti-staphylococcal penicillin are recommended, but this will require modi cation if there is history of penicillin allergy or evidence of drug resistance.…”

Section: Treatmentmentioning

confidence: 99%

“…Furthermore, up to a half of patients suffer residual morbidity, typically from cranial neuropathies. 1,4,[6][7][8][9] The guarded prognosis for septic CST in the antibiotic era may be due to delays in recognition of this condition and antecedant infection resulting in delays in treatment, as well as other complications developing concomitantly with septic CST.…”

Section: Introductionmentioning

confidence: 99%

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Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature

2002

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This article reviews the contemporary literature for septic cavernous sinus thrombosis (CST) with a focus on anticoagulation. Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Established treatments include high dose broad-spectrum parenteral antibiotics, and selective surgery for concurrent suppurations. The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the haemorrhagic sequelae of CST radiologically.

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“…The largest case series, published in India, included 14 children from 1985 to 1988; 11 of these children died, and the 3 survivors had permanent deficits. 11 More recently, a cohort in Thailand published in 2001 including 8 children over a 30-year time period 12 found favorable outcomes in 7. The purpose of this study is to describe clinical and radiologic features, diagnostic evaluation, management, and prognosis of this disease in a single-center consecutive cohort.…”

mentioning

confidence: 99%

Pediatric cavernous sinus thrombosis

et al. 2015

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Objective: To describe clinical characteristics, imaging findings, morbidity, and mortality in a single-center cohort of 12 pediatric cavernous sinus thrombosis cases and to review all cases available in recent English literature.Methods: Clinical data and radiographic studies on 12 cases from our institution were analyzed retrospectively. A literature search and review was conducted, with additional cases pooled with the new cohort for an aggregate analysis.Results: Twelve cases of cavernous sinus thrombosis in children from the Children's Hospital of Philadelphia between January 1, 2000, and December 31, 2013, were reviewed. All patients survived to discharge; 3 of 12 (25%) experienced neurologic morbidity. Contrast-enhanced MRI and contrast-enhanced head CT were 100% sensitive for detecting cavernous sinus thrombosis, while noncontrast time-of-flight magnetic resonance venography (TOF MRV) and noncontrast head CT were 0% sensitive. Literature review produced an additional 40 cases, and the aggregate mortality rate was 4 of 52 (8%) and morbidity rate was 10 of 40 (25%). Outcomes did not vary by treatment or with unilateral vs bilateral cavernous sinus involvement. There was a trend toward worse outcomes with fungal infections. Conclusion:Our case series demonstrates low morbidity and mortality with early, aggressive surgical, antimicrobial, and anticoagulation therapies. Although anticoagulation and surgery were not associated with significantly different outcomes, more study is needed. Neurology ® 2015;85:763-769 GLOSSARY CST 5 cavernous sinus thrombosis; ICA 5 internal carotid artery; MRA 5 magnetic resonance angiography; MRV 5 magnetic resonance venography; TOF MRV 5 time-of-flight magnetic resonance venography without contrast.

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Cavernous Sinus Thrombosis in Children

Cited by 14 publications

References 0 publications

Venous thrombosis in children

Venous thrombosis in children

Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature

Pediatric cavernous sinus thrombosis

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