Neonatal Cerebral Sinovenous Thrombosis From Symptom to Outcome

Abstract

Background and Purpose— Cerebral sinovenous thrombosis is a rare disease with severe neurological sequelae. The aim of this retrospective multicenter study was to investigate the clinical course, possible risk factors, and outcome of a cohort of neonatal patients with sinovenous thrombosis and, second, to estimate the incidence in The Netherlands. Methods— From January 1999 to March 2009, a review of all neonatal patients with sinovenous thrombosis from 6 tertiary neonatal intensive care units was performed. Population characteristics, clinical presentation, (prothrombotic) risk factors, neuroimaging, interventions, and neurodevelopment were evaluated. An estimated incidence was calculated based on the Netherlands Perinatal Registry. Results— Fifty-two neonates were included (39 boys) with a median gestational age of 39 weeks (range, 30 to 42 weeks; 5 preterm). An assisted or complicated delivery occurred in 32 of 52. Presenting symptoms developed at a median postnatal age of 1.5 days (range, 0 to 28 days) and consisted mainly of seizures (29 of 52). All sinovenous thrombosis cases were confirmed with MRI/MR venography. Multisinus thrombosis was most common followed by superior sagittal sinus thrombosis. FII G20210A mutation was present in 2 of 18 tested neonates (11%). Anticoagulation therapy (in 22 of 52) did not result in hemorrhagic complications. At follow-up (median age, 19 months; range, 3 to 72 months), moderate to severe neurological sequelae were present in 38%. The mortality was 10 of 52 (19%). A variable, although high yearly incidence of 1.4 to 12 per 100 000 term newborns was found. Conclusions— Neonatal sinovenous thrombosis is a multifactorial disease. The estimated incidence in The Netherlands seems higher than reported elsewhere.

Antithrombotic Therapy in Neonates and Children

“…The lesions Reported outcomes after neonatal CSVT include death in 7% to 19% and neurologic impairments in 36% to 79% of survivors. 383,384,386 Adverse neurologic outcomes include cognitive and motor defi cits and in 20% to 40%, epilepsy. 387 The presence of infarcts at diagnosis and perinatal complications predict worse outcome.…”

“…393 The most common anticoagulant used is LMWH. 386,392,394 LMWH has been reported to be safe even in the presence of signifi cant thalamic hemorrhage. 395 The optimal dose and duration of anticoagulant treatment is not known.…”

Manifestations and clinical impact of pediatric inherited thrombophilia

“…In a multicenter, retrospective review by Berfelo et al, 2 (5%) of 41 neonates tested had FVL and 2 (11%) of 18 neonates tested had PTM. 20 In a retrospective nationwide population-based study, 10 infants ,1 year of age, including 7 neonates, were diagnosed with CVT. Inherited thrombophilia was present in only 1 (13%) of the 8 patients tested.…”

Spectrum of magnetic resonance imaging abnormalities in neonatal seizures in a tertiary care hospital in India

“…CVST formed only less than 1 percentage in the present study as against the reported 5-13% of occurrence as a chance finding in cranial ultrasound. 25,26 We suggest performing MRA and MRV along with standard sequences in evaluation of neonatal seizures in order to detect vascular etiology.…”