Cerebral venous sinus thrombosis in children: a multicenter cohort from the United States.
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.
Wasay
Mohammad
M
Aga Khan University, Karachi, Pakistan. mohammad.wasay@aku.edu
Dai
Alper I
AI
Ansari
Mohsin
M
Shaikh
Zubair
Z
Roach
E S
ES
D000925:Anticoagulants / Q000627:therapeutic use; D020520:Brain Infarction / Q000401:mortality; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003244:Consciousness Disorders / Q000453:epidemiology; D003389:Cranial Nerve Diseases / Q000453:epidemiology; D003392:Cranial Sinuses / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009026:Mortality; D009123:Muscle Hypotonia / Q000453:epidemiology; D010211:Papilledema / Q000453:epidemiology; D010291:Paresis / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
D000925:Anticoagulants