Cerebral sinovenous thrombosis in the neonate.
BACKGROUND
There are few studies on neonatal cerebral sinovenous thrombosis (SVT).


OBJECTIVE
To describe the presentations, treatments, and outcomes of neonatal SVT and to assess infarction as a predictor of outcome.


METHODS
Retrospective chart study.


METHODS
A tertiary pediatric hospital in Indianapolis, Ind. Patients Forty-two children with neonatal SVT identified using International Classification of Diseases, Ninth Revision code searches from 1986 through June 2005 and review of neurology clinic records.


METHODS
None.


METHODS
Cognitive impairment, motor impairment, and epilepsy at last clinic visit.


RESULTS
Gestational or delivery complications or risk factors and comorbid conditions such as dehydration, sepsis, and cardiac defects were common (gestational/delivery factors in 82% [31 of 38 with available maternal data]; comorbid conditions in 62% [26 of the 42]). Twenty-four (57%) presented with seizures. Twenty-five (60%) had infarcts, which were hemorrhagic in 22. Only 27 (64%) of 42 received prothrombotic evaluations; none had persistent deficiencies of protein C, protein S, or antithrombin III. Three (7%) received heparin sodium. All other children received only supportive care. One child died. Outcome data were available for 29 (71%) of the 41 survivors; of these, 23 (79%) had impairment(s). Two were known to be in early intervention, and no further information was available. Of the remaining 27, 16 (59%) had cognitive impairment, 18 (67%) had cerebral palsy, and 11 (41%) had epilepsy. Infarction was associated with the presence of later impairment (P = .03).


CONCLUSIONS
The presentation of neonatal SVT is often nonspecific, the diagnosis can be difficult to make, treatment beyond supportive care is rarely used, and outcomes can be severe. Further work is needed to develop standardized guidelines for the evaluation and treatment of neonatal SVT.
Fitzgerald
Karima C
KC
Division of Pediatric Neurology, University School of Medicine, Indianapolis, IN 46202, USA.
Williams
Linda S
LS
Garg
Bhuwan P
BP
Carvalho
Karen S
KS
Golomb
Meredith R
MR
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009462:Neurology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000000981:diagnostic imaging / Q000209:etiology; D012851:Sinus Thrombosis, Intracranial / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome