Cerebral venous sinus thrombosis: a case series including thrombolysis.
BACKGROUND
Cerebral venous sinus thrombosis (CVST) in children is associated with a high incidence of serious morbidity and mortality. The presenting features are variable. It can be diagnostically challenging and the optimal treatment is uncertain.


OBJECTIVE
To describe the features of a series of children with CVST treated in a single paediatric neurology centre and to discuss the role of local thrombolysis.


METHODS
Electronic databases were searched using diagnostic labels and International Classification of Diseases (ICD) codes to identify children aged 1 month to under 17 years with CVST. Their records were reviewed.


RESULTS
21 children were identified over a period of 8.25 years with a median age of 7.1 years. The presenting symptoms included headache (15 children), vomiting (14 children) and visual disturbance (eight children). Signs found included papilloedema (16 children), fever (six children) and sixth nerve palsy (six children). The most common underlying condition was middle ear infection (13 children). All cases received unfractionated heparin and four severe cases received local pharmacological thrombolysis. 48% of cases had an adverse outcome (death, chronic intracranial hypertension, residual hemiparesis or sixth nerve palsy).


CONCLUSIONS
CVST has non-specific presenting features and a high risk of significant morbidity. CVST is typically found in association with a predisposing condition. Although heparin is the mainstay of treatment, thrombolysis may reverse deterioration as seen in three cases in this series. However, there is insufficient evidence to recommend the routine use of thrombolysis at present.
Mallick
A A
AA
Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK.
Sharples
P M
PM
Calvert
S E
SE
Jones
R W A
RW
Leary
M
M
Lux
A L
AL
O'Callaghan
F J
FJ
Osborne
J P
JP
Patel
J S
JS
Prendiville
A T
AT
Renowden
S
S
Jardine
P E
PE
D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D051271:Headache Disorders, Secondary / Q000209:etiology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology; D014839:Vomiting / Q000209:etiology
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator