Cerebral sinovenous thrombosis in children: diagnosis and treatment

• Published in: Pediatric emergency care Vol. 27; no. 9; p. 874
• Main Authors: Jackson, Benjamin F, Porcher, Frances K, Zapton, Daniel Tyler, Losek, Joseph D
• Format: Journal Article
• Language: English
• Published: United States 01.09.2011
• Subjects: Adolescent; Aftercare; Anti-Bacterial Agents - therapeutic use; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Child; Child, Preschool; Combined Modality Therapy; Fluid Therapy; Humans; Incidence; Infant; Infant, Newborn; Middle Ear Ventilation; Neuroimaging - methods; Otitis Media - complications; Otitis Media - drug therapy; Otitis Media - surgery; Prognosis; Sinus Thrombosis, Intracranial - diagnosis; Sinus Thrombosis, Intracranial - drug therapy; Sinus Thrombosis, Intracranial - epidemiology; Sinus Thrombosis, Intracranial - physiopathology; Sinus Thrombosis, Intracranial - rehabilitation; Sinus Thrombosis, Intracranial - surgery; South Carolina - epidemiology; Thrombectomy; Thrombophilia - complications; South Carolina
• ISSN: 1535-1815
• DOI: 10.1097/PEC.0b013e31822c9ccc

Cerebral sinovenous thrombosis (CSVT) is a pediatric stroke syndrome that occurs uncommonly in association with a number of common pediatric problems, most notably dehydration and infection-otitis media in older children, in particular. Cerebral sinovenous thrombosis involves considerable risk of morbidity and mortality. In the pediatric population, neonates are most commonly affected, but no age group is spared. The clinical manifestations of CSVT vary across age groups and include headache, nausea/vomiting, diplopia, seizures, altered mental status, cranial nerve palsies, and papilledema. Neuroimaging is critical to establishing the diagnosis, and although a variety of modalities are available, the diagnosis is most convincingly made via magnetic resonance imaging with venographic sequencing. Management of CSVT combines medical and surgical approaches and should occur in a multidisciplinary pediatric hospital setting. Anticoagulation is a controversial but generally recommended element of CSVT treatment. Prognosis is related to the extent of vessel and brain parenchymal involvement as well to timeliness of diagnosis and institution of therapy. Long-term follow-up should involve pediatric neurology and ophthalmology and, whenever indicated, rehabilitational therapy as well.