Paediatric arterial ischaemic stroke and cerebral sinovenous thrombosis

Abstract

Data from large case series of children with cerebral thrombotic events are pivotal to improve prevention, early recognition and treatment of these conditions. The Italian Registry of Pediatric Thrombosis (R. I. T. I.) was established in 2007 by a multidisciplinary team, aiming for a better understanding of neonatal and paediatric thrombotic events in Italy and providing a preliminary source of data for the future development of specific clinical trials and diagnostic-therapeutic protocols. We analysed data relative to the paediatric cerebral thrombotic events of the R. I. T. I. which occurred between January 2007 and June 2012. In the study period, 79 arterial ischaemic stroke (AIS) events (49 in males) and 91 cerebral sinovenous thrombosis (CSVT) events (65 in males) were enrolled in the R. I. T. I. Mean age at onset was 4.5 years in AIS, and 7.1 years in CSVT. Most common modes of presentation were hemiparesis, seizures and speech disturbances in AIS, and headache, seizures and lethargy in CSVT. Most common etiologies were underlying chronic diseases, vasculopathy and cardiopathy in AIS, and underlying chronic diseases and infection in CSVT. Time to diagnosis exceeded 24 hours in 46 % AIS and 59 % CSVT. Overall data from the Italian Registry are in substantial agreement with those from the literature, despite small differences. Among these, a longer time to diagnosis compared to other registries and case series poses the accent to the need of an earlier recognition of paediatric cerebrovascular events in Italy, in order to enable prompt and effective treatment strategies.

Cerebral venous sinus thrombosis

“…The annual incidence of CVST in the pediatric population is approximately seven cases per million and is higher in neonates than in children . The sex ratio seems balanced because of the absence of sex‐specific risk factors .…”

“…The longest observational period was described in a large prospective study that included 104 neonates followed for a median period of 2.5 years (range 6 months to 15 years) . Prognosis in children seems worse than in adults, with 20–70% of patients presenting residual neurological deficits . In a series of 42 neonates, one died and only 21% of those who completed 2 years of follow‐up recovered completely .…”

“…This happens particularly in the thrombosis of the superior sagittal sinus (OR, 2.5; 95% CI, 1.07–5.67) . In children and adolescents, head and neck infections (otitis media, mastoiditis and sinusitis) are the most common risk factors for CVST . Other risk factors observed in more than 50% of cases include underlying chronic diseases such as nephrotic syndrome (which confers an acquired prothrombotic state due to urinary loss of anticoagulant proteins) , liver diseases , systemic lupus erythematosus , malignancy , head trauma or neurosurgery .…”

Cerebral Sinovenous Thrombosis Mimicking Intracranial Mass

“…Most common signs and symptoms are seizure, lethargy, and headache [1,2,3]. We herein report a case diagnosed as cerebral sinovenous thrombosis mimicking an intracranial mass and presenting with increased intracranial pressure symptoms in an adolescent girl.…”

Stroke in children. Formation of the pediatric register: international and regional experience

“…другие регистры инсульта у детей Помимо описанных выше регистров, сбор данных о случаях детского инсульта также проводится в рамках международного исследования детского ИИ (International Pediatric Stroke Study, IPSS) [23], Датского национального регистра пациентов [23,24] и базы данных Калифорнии. Исследование, проведенное с использованием информации базы данных Калифорнии, включившей 2278 пациентов с первичным инсультом в возрасте от 1 мес до 19 лет (при этом частота случаев инсульта составила 2,3 на 100 тыс.…”