Cerebral venous sinus thrombosis: a case series including thrombolysis

Mallick, Andrew A; Sharples, Peta M.; Calvert, Sophie E; Jones, R. Watson; Leary, Mick; Lux, Andrew; O'Callaghan, Finbar; Osborne, J. P.; Patel, Jayesh; Prendiville, A; Renowden, Shelley; Jardine, Philip

doi:10.1136/adc.2008.154708

Cited by 42 publications

(25 citation statements)

References 35 publications

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“…The incidence in Europe and North America is estimated at 0.6 per 100,000 per year in childhood, with a male predominance (60–70%), and neonates accounting for 30–50% of cases (1, 2). The cerebral venous system is composed of a network of cortical, medullary, and deep veins which drain into dural venous sinuses.…”

Section: Definitions Incidence and Spectrum Of Diseasementioning

confidence: 99%

Cerebral Sinovenous Thrombosis

Ichord

2017

Front. Pediatr.

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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.

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Section: Definitions Incidence and Spectrum Of Diseasementioning

confidence: 99%

Cerebral Sinovenous Thrombosis

Ichord

2017

Front. Pediatr.

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“…In the literature, prothombotic factors have been found with a rate of 24-64% in children in the post-neonatal period (1,2,8,(10)(11)(12). Conditions including head and neck traumas and infection (especially sinusitis, mastoiditis, meningitis) are in the first orders in the etiology (18,19,22). In our series, mastoiditis was observed in four patients.…”

Section: Discussionmentioning

confidence: 50%

“…The median age of occurrence of thrombosis was 14 years. In the literature, the median age has been found to be approximately 2-fold higher according to the studies including patients who were in the post-neonatal period (18,19). The most common cause of presentation was headache.…”

Section: Discussionmentioning

confidence: 99%

“…On brain MRI performed in the third month in this patient, encephalomalacia was found, but neurological examination was found to be normal. In the pediatric age group, the mortality rate related with cerebral sinovenous thrombosis is below 10%, but neurological defects may be observed at the time of discharge or during the follow-up in 17-79% of the patients; long-term rehabilitation may be needed because of motor and cognitive sequelae (2,10,18,(32)(33)(34). Young age, coma, seizure and focal neurological findings have been found to be related with poor prognosis (2).…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of cases with cerebral thrombosis in children

et al. 2016

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Aim: We aimed to evaluate the patients who were followed up in our clinic with a diagnosis of cerebral sinovenous thrombosis in terms of age, sex, clinical findings, etiology, thrombophilic factors, imaging findings, treatment and prognosis. Material and Methods:The files of 11 patients who were followed up in our pediatric neurology clinic with a diagnosis of cerebral thrombosis between 1 December 2010 and 31 December 2014 were retrospectively analyzed. Results:Seven of 11 patients were male (63.6%). The median age was 14 years (2-17 years). Six (54%) of the patients presented with a complaint of headache. Other complaints at presentation included diplopia (n:3), weakness and difficulty in speaking (n:1) and seizure (n:1). A diagnosis of pseudotumor cerebri was made in eight of the patients (72.7%). In the etiology, mastoiditis was found in three patients, mastoiditis and meningitis were found in combination in one patient, Behçet's disease was found in three patients and head trauma was found in one patient. In 3 patients, only prothrombotic genetic risk factors were present; one patient had deficiency of protein C and S, one patient had deficiency of antithrombin III and one patient had hyperhomosisteinemia in association with vitamin B12 deficiency. 1A homozygous MTFHR A1298C mutation was detected in the patient who had mastoiditis and meningitis and protein S deficiency and lupus anticoagulant were found in another patient who had mastoiditis. All patients received anticoagulant treatment and all patients recovered without neurological sequelae except one.Conclusions: Cerebral sinovenous thrombosis should be considered in patients who present with headache and focal neurological deficits. Appropriate utilization of imaging studies is necessary for the diagnosis. Detailed ear, nose and throat examination should be performed to detect mastoiditis. It is recommended that genetic risk factors should be investigated, because hereditary thrombophilis factors may have a role in children. Behçet's disease which is relatively common in our country should be considered in differential diagnosis. (Turk Pediatri Ars 2016; 51: 87-93)

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“…Têm sido relatados casos isolados de sucesso em crianças em coma e com trombose extensa do sistema venoso superficial e profundo. 35,36 No nosso caso de trombose maciça de todos os seios venosos foi efetuada trombólise local pela neurorradiologia de intervenção, com sucesso. Na literatura, a mortalidade na TVC ronda os 10% com sequelas nos sobreviventes entre os 17-79%.…”

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Acidentes Vasculares Cerebrais em Idade Pediátrica: O Papel dos Cuidados Intensivos

Ferreira

Rebelo

Aguilar

et al. 2017

Acta Pediátrica Port

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Acta Pediatr Port 2017;48:245-52Resumo Introdução: As lesões vasculares do sistema nervoso central, nomeadamente o acidente vascular cerebral hemorrágico, o acidente vascular cerebral isquémico e trombose venosa cerebral, são causa importante de morbilidade e mortalidade. Existem poucos estudos sobre a melhor abordagem terapêutica em pediatria. O objetivo deste estudo foi descrever a abordagem e outcome neurológico dos doentes admitidos numa unidade de cuidados intensivos pediátricos com lesões vasculares cerebrais não traumáticas. Métodos: Estudo retrospetivo baseado nos processos clínicos de doentes internados numa unidade de cuidados intensivos pediátricos entre janeiro de 2007 e dezembro de 2013 com lesão vascular cerebral não traumática. Resultados: Incluíram-se 45 doentes, mediana da idade 8,2 anos, 70% do sexo masculino. Ocorreram 22 casos (49%) de acidente vascular cerebral hemorrágico, 15 de acidente vascular cerebral isquémico (33%) e oito de trombose venosa cerebral (18%). Necessitaram de intervenção neurocirúrgica 18 doentes e neurorradiológica cinco doentes. Um doente fez trombólise sistémica utilizando alteplase, 76% necessitaram de controlo médico da hipertensão intracraniana, 57% de ventilação mecâ-nica, 30% de suporte cardiovascular e 28% de terapêutica antiepilética. Ocorreram cinco óbitos (11%), quatro em doentes com acidente vascular cerebral hemorrágico. Utilizando a escala KOSCHI (King's Outcome Scale for Childhood Head Injury), atualmente 23 (51%) doentes são independentes, incluindo 17 que não apresentam qualquer sequela. Discussão: Registaram-se, em média, seis internamentos por ano por acidente vascular cerebral não traumático, sendo mais frequente o hemorrágico. A precocidade do diagnóstico e a referenciação atempada para centros especializados são cruciais para a melhoria do prognóstico. A abordagem multidisciplinar num centro com disponibilidade permanente de recursos humanos e materiais terá contribuído para a sobrevida e boa recuperação funcional verificada na maioria dos casos. Palavras-chave:Acidente Vascular Cerebral; Criança; Unidades de Cuidados Intensivos Pediátricos; Trombose Venosa Abstract Introduction: Vascular brain lesions, including haemorrhagic stroke, ischaemic stroke and cerebral venous thrombosis, are important causes of morbidity and mortality. Paediatric studies regarding the best therapeutic approach are scarce. The aim of this study was to describe the therapeutic approach and neurological outcome in patients admitted to a paediatric intensive care unit with non-traumatic vascular brain lesions. Methods: A retrospective analysis was conducted using medical records of patients with non-traumatic vascular brain lesions admitted to a paediatric intensive care unit between January 2007 and December 2013. Results: Forty-five patients were included, 70% male, median age 8.2 years. There were 22 cases (49%) of haemorrhagic stroke, 15 (33%) of ischaemic stroke and

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Cerebral venous sinus thrombosis: a case series including thrombolysis

Cited by 42 publications

References 35 publications

Cerebral Sinovenous Thrombosis

Cerebral Sinovenous Thrombosis

Evaluation of cases with cerebral thrombosis in children

Acidentes Vasculares Cerebrais em Idade Pediátrica: O Papel dos Cuidados Intensivos

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