Cerebral Venous Sinus Thrombosis in Children: A Multicenter Cohort From the United States

Wasay, Mohammad; Dai, Alper; Ansari, Mohsin; Shaikh, Zubair; Roach, E. Steve

doi:10.1177/0883073807307976

Cited by 140 publications

(134 citation statements)

References 29 publications

(22 reference statements)

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“…Two other cases one with HbSC and one with HbSS were reported as part of a registry of 42 patients with DVST [5]. A third case was reported in registry of 63 patients from North America [8]. Two patients with sickle cell trait and DVST have also been reported [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Two patients with sickle cell trait and DVST have also been reported [9,10]. DVST is a rare disorder with an estimated annual incidence of 3-4 per million adults and up to 7 per million among children [8]. The incidence in patients with SCD is unknown as it has not been reported in the stroke trials of Cooperative Study of Sickle Cell Disease (CSSCD).…”

Section: Discussionmentioning

confidence: 99%

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Venous sinus thrombosis leading to stroke in a patient with sickle cell disease on hydroxyurea and high hemoglobin levels: Treatment with thrombolysis

et al. 2008

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A 21-year-old man with homozygous sickle cell disease maintained on hydroxyurea for 1 year developed thrombosis of the superior sagittal, right transverse, and right sigmoid dural sinuses with a large venous infarct. He was successfully treated with endovascular thrombolysis. Investigation did not reveal any inherited or acquired hypercoagulable state. This patient however had consistently elevated hemoglobin levels both at the time of the initial event and on follow up. One year later he developed symptomatic avascular necrosis of the right hip. High hemoglobin levels resulting from hydroxyurea therapy may have contributed to development of complications in this patient. Am. J. Hematol. 83:818-820, 2008. V

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Venous sinus thrombosis leading to stroke in a patient with sickle cell disease on hydroxyurea and high hemoglobin levels: Treatment with thrombolysis

et al. 2008

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“…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. 86 Up to 30% of cases have reported venous infarction with subsequent hemorrhage.…”

Section: Venous Thrombosismentioning

confidence: 99%

“…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%

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The evaluation and management of postnatal thromboses

Saxonhouse

Burchfield

2009

J Perinatol

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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...

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