Anticoagulation therapy and imaging in neonates with a unilateral thalamic hemorrhage due to cerebral sinovenous thrombosis.
OBJECTIVE
Cerebral sinovenous thrombosis is a rare disorder with a high risk of an adverse neurodevelopmental outcome. Until now, anticoagulation therapy has been restricted to neonates without an associated parenchymal hemorrhage. In this study, we describe sequential neuroimaging findings and use of anticoagulation therapy in newborn infants with a unilateral thalamic hemorrhage due to cerebral sinovenous thrombosis.


METHODS
Ten neonates with a unilateral thalamic hemorrhage and cerebral sinovenous thrombosis were studied. Diagnosis was suspected using cranial ultrasound and confirmed with MRI/MR venography. Eight infants had a repeat MRI at 3 to 7 months. Neurodevelopmental outcome was assessed from 3 months until 5 years.


RESULTS
One infant died. Seven infants were treated with low-molecular-weight heparin. No side affects were noted. MRI showed involvement of multiple sinuses, additional intraventricular hemorrhage, and white matter lesions in all infants. Recanalization was present on the repeat MRI at 3 months in all infants. Treatment was delayed in one infant and anticoagulation was started only after extension of the thalamic hemorrhage. He required a ventriculoperitoneal drain for posthemorrhagic ventricular dilatation and developed cerebral visual impairment and global delay. Two other infants showed global delay and one of them also developed postneonatal epilepsy. Mild asymmetry in tone was present in 4 children.


CONCLUSIONS
Cerebral sinovenous thrombosis was found in 10 neonates with unilateral thalamic hemorrhage. Diagnosis was suspected on cranial ultrasound and confirmed with MRI/MR venography. Treatment with low-molecular-weight heparin in newborn infants with a thalamic hemorrhage due to cerebral sinovenous thrombosis appears to be safe and should be considered. Long-term follow-up will be needed to assess cognitive outcome.
Kersbergen
Karina J
KJ
Department of Neonatology, KE 04.123.1, University Medical Center Utrecht/Wilhelmina Children's Hospital, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
de Vries
Linda S
LS
van Straaten
H L M Irma
HL
Benders
Manon J N L
MJ
Nievelstein
Rutger A J
RA
Groenendaal
Floris
F
D000925:Anticoagulants / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012851:Sinus Thrombosis, Intracranial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D013786:Thalamic Diseases / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D018608:Ultrasonography, Doppler / Q000379:methods
D000925:Anticoagulants