Cerebral venous sinus thrombosis in children: a multicenter cohort from the United States

• Published in: Journal of child neurology Vol. 23; no. 1; p. 26
• Main Authors: Wasay, Mohammad, Dai, Alper I, Ansari, Mohsin, Shaikh, Zubair, Roach, E S
• Format: Journal Article
• Language: English
• Published: United States 01.01.2008
• Subjects: Anticoagulants - therapeutic use; Brain Infarction - mortality; Causality; Child; Child, Preschool; Cohort Studies; Comorbidity; Consciousness Disorders - epidemiology; Cranial Nerve Diseases - epidemiology; Cranial Sinuses - pathology; Cranial Sinuses - physiopathology; Female; Humans; Hydrocephalus - mortality; Infant; Infant, Newborn; Male; Mortality; Muscle Hypotonia - epidemiology; Papilledema - epidemiology; Paresis - epidemiology; Prognosis; Retrospective Studies; Sinus Thrombosis, Intracranial - drug therapy; Sinus Thrombosis, Intracranial - mortality; Sinus Thrombosis, Intracranial - physiopathology; Thrombolytic Therapy - statistics & numerical data; United States - epidemiology; United States
• ISSN: 0883-0738
• DOI: 10.1177/0883073807307976

This study presents a large multicenter cohort of children with cerebral venous thrombosis from 5 centers in the United States and analyzes their clinical findings and risk factors. Seventy patients were included in the study (25 neonates, 35%). The age ranged from 6 days to 12 years. Thirty-eight (55%) were younger than 6 months of age, and 28 (40%) were male. Presenting features included seizures (59%), coma (30%), headache (18%), and motor weakness (21%). Common neurological findings included decreased level of consciousness (50%), papilledema (18%), cranial nerve palsy (33%), hemiparesis (29%), and hypotonia (22%). Predisposing factors were identified in 63 (90%) patients. These included infection (40%), perinatal complications (25%), hypercoagulable/hematological diseases (13%), and various other conditions (10%). Hemorrhagic infarcts occurred in 40% of the patients and hydrocephalus in 10%. Transverse sinus thrombosis was more common (73%) than sagittal sinus thrombosis (35%). Three children underwent thrombolysis, 15 patients received anticoagulation, and 49 (70%) were treated with antibiotics and hydration. Nine (13%) patients (6 of them neonates) died. Twenty-nine patients (41%) were normal, whereas 32 patients (46%) had a neurological deficit at discharge. Seizures and coma at presentation were poor prognostic indicators. In conclusion, cerebral venous thrombosis predominantly affects children younger than age 6 months. Mortality is high (25%) in neonatal cerebral venous thrombosis. Only 18 (25%) patients were treated with anticoagulation or thrombolysis.