Cerebral Sinovenous Thrombosis in Children

deVeber, Gabrielle; Andrew, Maureen; Adams, Carlton Z.; Björnson, Bruce; Booth, Frances A.; Buckley, David; Camfield, Carol; David, Michèle; Humphreys, Peter; Langevin, Pierre; Macdonald, Eilidh; Gillett, J.; Meaney, Brandon; Shevell, Michael; Sinclair, D.B.; Yager, Jerome Y.

doi:10.1056/nejm200108093450604

Cited by 994 publications

(881 citation statements)

References 28 publications

Supporting

Mentioning

761

Contrasting

Unclassified

Order By: Relevance

“…45 The frequency of this complication is probably underestimated as brain CT can initially be normal and vascular MRI not always performed. 46,47 As vascular MRI allows better definition of cerebral tissues such exam has to be recommended. Thrombosis are currently under review in the FRALLE protocols.…”

Section: Discussionmentioning

confidence: 99%

Age and high-dose methotrexate are associated to clinical acute encephalopathy in FRALLE 93 trial for acute lymphoblastic leukemia in children

et al. 2006

View full text Add to dashboard Cite

The objective of the study was to assess acute neurotoxicity associated with triple intrathecal therapy (TIT)7high-dose methotrexate (HD MTX) in children with acute lymphoblastic leukemia (ALL). 1395 children were enrolled on FRALLE 93 protocol from 1993 to 1999. Lower-risk group (LR, n ¼ 182) were randomized to weekly low-dose MTX at 25 mg/m 2 /week (LD MTX, n ¼ 81) or HD MTX at 1.5 g/m 2 /2 weeks Â 6 (n ¼ 77). Intermediate-risk group (IR, n ¼ 672) were randomized to LD MTX (n ¼ 290) or HD MTX at 8 g/m 2 /2 weeks Â 4 (n ¼ 316). Higherrisk group (HR, n ¼ 541) prednisone-responder patients received LD MTX and cranial radiotherapy. HR group steroid resistant cases were grafted (autologous or allogenic). TIT (MTX, cytarabine and methylprednisolone) was given every 2 weeks during 16-18 weeks and every 3 months during maintenance therapy in LR and IR patients. 52 patients (3.7%) developed neurotoxicity. Isolated seizures: n ¼ 15 (1.1%), peripheral and spinal neuropathy: n ¼ 17 (1.2%) and encephalopathy: n ¼ 20 (1.4%). Age 410 years was significantly associated with neurotoxicity (P ¼ 0.01) and use of HD MTX is associated with encephalopathy (P ¼ 0.03). Sequels are reported respectively in 60 and 33% of spinal neuropathy and encephalopathy cases. Current strategies tailoring risk of neurological sequels has to be defined.

show abstract

Section: Discussionmentioning

confidence: 99%

Age and high-dose methotrexate are associated to clinical acute encephalopathy in FRALLE 93 trial for acute lymphoblastic leukemia in children

et al. 2006

View full text Add to dashboard Cite

show abstract

“…The second group consists of conditions causing blood flow disturbance. The third group comprises all causes of inflammation, infection, or damage to the sinus wall [3].The classic presentation of CST is severe illness associated with typically high and swinging fever. As the clot proliferates along the sinus, it is accompanied by peri-venous inflammation, tenderness, and jugular lymphadenopathy.…”

Section: Introductionmentioning

confidence: 99%

Cavernous Sinus Thrombosis of Nasal Origin in Children

Varshney

Malhotra

Gupta

et al. 2014

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

Cavernous sinus thrombosis is a rare presentation. Early diagnosis and aggressive treatment are required to prevent morbidity and mortality. Nasal infections can give rise to serious intracranial complications. Presented here is a case series of cavernous sinus thrombosis of nasal septic origin. The purpose of this article is to report our experience in pediatric patients with this illness to ascertain a clinical course and outcomes for further clinical application. Eight (08) cases of nasalseptic origin of cavernous sinus thrombosis ata tertiary care teaching hospital in the north India region of India were included in the study. Cases presented with various symptoms like headache, proptosis, ophthalmoplegia and fever. The patients were investigated by doing High Resolution Computed Tomography of nose & PNS and brain with intravenous contrast. The cases were treated with intravenous broad spectrum antibiotics. Eight patients less than 16 years of age (mean age of 11.2 years)diagnosed with cavernous sinus thrombophlebitis due to nasal septic focus over the period of 05 years were reviewed retrospectively. The predisposing infections and causative microorganisms were similar to previous reports in children. A conservative management strategy with antibiotics gave a good prognosis in these cases. There were no deaths. Early recognition of this condition, the appropriate selection of empirical antibiotic therapy, and the awareness of associated complication were the key factors leading to excellent outcome.

show abstract

“…The incidence of cerebral sinovenous thrombosis (CSVT) in childhood is estimated at 0.67 per 100 000 children per year with approximately half occurring in neonates. 25,26 Major presenting clinical features of CSVT include seizures, fever and lethargy. 25,26 The most recent review of infants with CSVT found that 90% had predisposing factors identified (Table 2), with 16% of these patients having multiple risk factors.…”

Section: Venous Thrombosismentioning

confidence: 99%

“…25,26 Major presenting clinical features of CSVT include seizures, fever and lethargy. 25,26 The most recent review of infants with CSVT found that 90% had predisposing factors identified (Table 2), with 16% of these patients having multiple risk factors. 26 The superior and lateral sinuses are the most frequently involved vessels.…”

Section: Venous Thrombosismentioning

confidence: 99%

The evaluation and management of postnatal thromboses

Saxonhouse

Burchfield

2009

J Perinatol

View full text Add to dashboard Cite

In the pediatric population, neonates have the highest risk for thromboembolism (TE), most likely due to the frequent use of intravascular catheters. This increased risk is attributed to multiple risk factors. Randomized clinical trials dealing with management of postnatal thromboses do not exist, thus, opinions differ regarding optimal diagnostic and therapeutic interventions. This review begins with an actual case study illustrating the complexity and severity of these types of cases, and then evaluates the neonatal hemostatic system with discussion of the common sites of postnatal thrombosis, perinatal and prothrombotic risk factors, and potential treatment options. A proposed step-wise evaluation of neonates with symptomatic postnatal thromboses will be suggested, as well as future research and registry directions. Owing to the complexity of ischemic perinatal stroke, this topic will not be reviewed. Case study A full-term male infant born through spontaneous vaginal delivery was admitted to the neonatal intensive care unit (NICU) shortly after birth due to a history of low APGAR scores and respiratory distress requiring mechanical ventilation. The pregnancy was complicated by gestational diabetes treated with glyburide and chorioamnionitis was evident during labor. The patient was started on ampicillin and gentamicin and appropriate fluid resuscitation was initiated. The patient improved over the next few days and was able to be weaned off of ventilator support. The patient had an umbilical arterial catheter (UAC) placed after birth that was removed on day 3 of life.On day 4 of life the patient's legs appeared pale. Physical examination demonstrated cool lower extremities and markedly decreased pulses in the feet. Over the previous 24 h, urine output declined significantly.Ultrasound (US) examination of the heart, major vessels and abdomen demonstrated a large thrombus in the descending aorta with very minimal flow to the renal and iliac arteries. A literature search did not reveal any level I management guidelines for thrombosis in neonatal patients, and consideration is now given to surgical thrombectomy, anticoagulation therapy or fibrinolytic therapy. Incidence of neonatal thromboembolic diseaseAlthough neonates have the highest risk of thromboembolism (TE) in the pediatric population, the incidence of postnatal TE varies due to the types of thromboses that were reported and how aggressively centers screened for thromboses. 1 Data from the three international registries are displayed in Table 1. All three registries observed that thromboses occurred in both term and preterm infants and affected male and female infants equally, other than renal vein thrombosis (RVT) that affected more male neonates. [2][3][4] These registries also demonstrated that approximately 90% of venous thromboses in neonates were associated with central venous catheters (CVLs). [2][3][4] The recurrence rate of TE following symptomatic neonatal events ranges from 3.3 to 7%. 5 The international registries are the first step toward...

show abstract

Cerebral Sinovenous Thrombosis in Children

Abstract: Sinovenous thrombosis in children affects primarily neonates and results in neurologic impairment or death in approximately half the cases. The occurrence of venous infarcts or seizures portends a poor outcome.

Cited by 994 publications

References 28 publications

Age and high-dose methotrexate are associated to clinical acute encephalopathy in FRALLE 93 trial for acute lymphoblastic leukemia in children

Age and high-dose methotrexate are associated to clinical acute encephalopathy in FRALLE 93 trial for acute lymphoblastic leukemia in children

Cavernous Sinus Thrombosis of Nasal Origin in Children

The evaluation and management of postnatal thromboses

Contact Info

Product

Resources

About