Cerebral Venous Sinus Thrombosis in Preterm Infants

Abstract

BACKGROUND: Neonatal cerebral venous sinus thrombosis (CVST) can lead to brain injury and neurodevelopmental impairments. Previous studies of neonatal CVST have focused on term infants, and studies of preterm infants are lacking. In this study, we examined the clinical and radiological features, treatment and outcome of CVST in preterm infants. METHODS: This was a retrospective, consecutive cohort study of preterm infants (gestational age <37 weeks) with radiologically confirmed CVST. All magnetic resonance imaging/MRV and CT/CTV scans were re-reviewed to study thrombus characteristics and pattern of brain injury. Outcome was assessed by the validated pediatric stroke outcome measure at the most recent clinic visit. RESULTS: Twenty-six preterm infants with CVST were studied. Of these, 65% were moderate-late preterm (32–37 weeks), 27% very preterm (28–32 weeks), and 8% extreme preterm (<28 weeks). Most (73%) were symptomatic at presentation with seizures or abnormal exam. Transverse (85%) and superior sagittal (42%) sinuses were common sites of thrombosis. Parenchymal brain injury was predominantly periventricular (35%) and deep white matter (31%) in location. Intraventricular hemorrhage occurred in 46%. Most infants (69%) were treated with anticoagulation. No treated infant (including eleven with pretreatment hemorrhage) had new or worsening post-treatment hemorrhage. Outcomes ranged from no deficits (50%), mild-moderate (25%), and severe (25%) impairment. CONCLUSIONS: In our sample of preterm infants with CVST, more than one-quarter were asymptomatic. White matter brain lesions predominated and one-half had neurological deficits at follow-up. Anticoagulation of preterm CVST in this small cohort appeared to be safe. Larger studies of preterm CVST are needed.

Clinical characteristics, anticoagulation therapy, and short-term outcomes of neonatal cerebral sinovenous thrombosis: a cross-sectional study from a Chilean center

“…Maternal diseases, such as preeclampsia and gestational diabetes, can induce hypercoagulability, endothelial damage, and subsequent placental infarction and cerebrovascular dysfunction. Other factors, including premature rupture of membranes, instrumental delivery, perinatal asphyxia or HIE, dehydration, infections, thrombophilias, and cardiac disorders, are also associated with the development of SVT [1][2][3][4].…”

“…Sinovenous thrombosis (SVT) is a disorder involving the partial or complete occlusion of one or more cranial veins or sinuses, resulting in the obstruction of blood ow and potential brain damage [1]. The higher incidence of SVT in neonates (6.6 cases per 100,000 live births per year) compared to the rest of the pediatric population (0.7 cases per 100,000 children per year) is likely attributed to the complex interplay of various antenatal, perinatal, and postnatal prothrombotic conditions that are unique to this developmental stage [1][2][3][4]. However, given the subtle and overlapping neurological symptoms at presentation, neonatal SVT is presumably underdiagnosed and can be easily mistaken for other neurological disorders.…”

“…However, given the subtle and overlapping neurological symptoms at presentation, neonatal SVT is presumably underdiagnosed and can be easily mistaken for other neurological disorders. Therefore, early detection may be missed without appropriate imaging studies of cerebral venous circulation [2,4,5].…”

Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association

“…Anticoagulation in the acute phase is more controversial in premature and term neonates but is reasonable because there is no evidence of posttreatment hemorrhage, whereas lack of anticoagulation may lead to thrombus propagation. 65,66 CVT in children carries a mortality rate of 3%, and recurrent venous thrombosis occurs in ≈6%, usually associated with no administration of anticoagulation and lack of venous recanalization. 64 Since the prior scientific statement, 1 there have been randomized trials on duration of anticoagulation and the use of DOACs.…”

Clinical Values of Coagulation Factors X, XI, and XII in Cerebral Venous Sinus Thrombosis During Perinatal State

“…3 If left untreated, CVST can lead to serious complications, such as stroke, cerebral edema, and hydrocephalus. 4,5 The exact cause of CVST is not known, but it is believed to be related to a combination of factors such as genetics, infection, and blood clotting disorders. 6 It has been hypothesized that the increased levels of hormones during pregnancy may contribute to increased clotting of the veins that drain blood from the brain, leading to clot formation.…”