Cerebral Sinovenous Thrombosis

Abstract

Cerebral sinovenous thrombosis (CSVT) is a rare but serious cerebrovascular disorder affecting children from the newborn period through childhood and adolescence. The incidence is estimated at 0.6/100,000/year, with 30–50% occurring in newborns. Causes are diverse and are highly age dependent. Acute systemic illness is the dominant risk factor among newborns. In childhood CSVT, acute infections of the head and neck such as mastoiditis are most common, followed by chronic underlying diseases such as nephrotic syndrome, cancer, and inflammatory bowel disease. Signs and symptoms are also age related. Seizures and altered mental status are the commonest manifestations in newborns. Headache, vomiting, and lethargy, sometimes with 6th nerve palsy, are the most common symptoms in children and adolescents. Recent multicenter cohort studies from North America and Europe have provided updated information on risk factors, clinical presentations, treatment practices, and outcomes. While systemic anticoagulation is the most common specific treatment used, there are wide variations and many uncertainties even among experts concerning best practice. The treatment dilemma is especially pronounced for neonatal CSVT. This is due in part to the higher prevalence of intracranial hemorrhage among newborns on the one hand, and the clear evidence that newborns suffer greater long-term neurologic morbidity on the other hand. With the advent of widespread availability and acceptance of acute endovascular therapy for arterial ischemic stroke, there is renewed interest in this therapy for children with CSVT. Limited published evidence exists regarding the benefits and risks of these invasive therapies. Therefore, the authors of current guidelines advise reserving this therapy for children with progressive and severe disease who have failed optimal medical management. As research focused on childhood cerebrovascular disease continues to grow rapidly, the future prospects for improving knowledge about this disorder should be good.

Fusobacterium necrophorum, a major provider of sinus thrombosis in acute mastoiditis: A retrospective multicentre paediatric study

“…This proposed flowchart takes into account the fact that, unlike other classic otogenic bacteria, F necrophorum has a specific thrombotic activity by producing hemagglutinin and cytokines which lead to platelet aggregation and inflammation . This seems to be a main risk factor for cerebral sinovenous thrombosis …”

Cerebral sinovenous thrombosis as a complication of otitis media

“…A high proportion (35%‐43%) of cases occur in newborns due to multiple risk factors in this age‐group including infections, birth trauma, hypoxic injury, dehydration, cardiac defects, and prothrombotic states . Chronic illnesses, such as inflammatory bowel disease, nephrotic syndrome, systemic lupus erythematous, and leukemia (especially when treated with L‐asparaginase), increase the risk of CSVT in older children . Acute head and neck infections (otitis media, mastoiditis, and sinusitis) represent the most common predisposing factors in previously healthy children .…”

“…Thrombosis of the cerebral sinuses impedes blood flow and causes increased venous pressure which in turn results in increased ICP. In some cases,retrograde venous pressure decreases cerebral blood flow causing cerebral ischemia and infarction . Clinical features can be subtle and nonspecific, such as ear pain, fever, headache, irritability, and vomiting.…”

“…Clinical features can be subtle and nonspecific, such as ear pain, fever, headache, irritability, and vomiting. As the condition progresses, signs of increased ICP become more evident such as diplopia (cranial nerve VI palsy), papilledema, altered mental status, seizure, and coma . Mastoiditis is not always clinically evident at the time of presentation.…”

Serum levels of advanced glycation end products in type II diabetic patients with acute cerebral infarction

“…Clinical manifestations include symptoms and body signs of focal cerebral dysfunction, such as cognitive disorder, sensory dysfunction, paralysis, or aphasia. The observation of carotid artery AS plaque is an important indicator for preventing the development of cerebral thrombosis [20][21][22].…”