A Comprehensive Examination of Clinical Characteristics and Determinants of Long-Term Outcomes in Pediatric Cerebral Sinus Venous Thrombosis

• Published in: Pediatric neurology 2024-06, Vol.155, p.76-83
• Main Authors: Karakas, Cemal, Herman, Isabella, Kralik, Stephen F., Webber, Troy A., Takacs, Danielle S., Bhar, Saleh, Pehlivan, Davut
• Format: Article
• Language: English
• Subjects: Adolescent; Anticoagulants - therapeutic use; Child; Child, Preschool; CSVT; Female; Follow-Up Studies; Humans; Infant; Infarction; Male; Pediatric stroke; Retrospective Studies; Risk Factors; Sinus Thrombosis, Intracranial - diagnostic imaging; Sinus Thrombosis, Intracranial - therapy; Venous thrombosis
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2024.03.022

To analyze the clinical and neuroimaging features, risk factors, treatment choices, and long-term clinical outcomes in children with cerebral sinus venous thrombosis (CSVT). This is a retrospective cohort study of children diagnosed with CSVT between 2002 and 2018 at Texas Children's Hospital. A total of 183 children (male: 62.3%) with CSVT were included. The average presenting age was 7.7 years (S.D.: 5.6). The mean follow-up duration was 33.7 months (S.D.: 38.6). The most common presenting clinical feature was headache (36.6%). Head and neck infections other than meningitis (36.6%) were the most common risk factors. Prevalent neurological examination findings included motor deficit (21.3%) and altered mental status (AMS, 20.2%). Neuroimaging features included hemorrhagic infarction (19.6%), ischemic infarction (8.2%), and intracranial hemorrhage without infarction (5.5%). The most common site of thrombosis was the superior sagittal sinus (37.2%), with 78.2% of patients demonstrating involvement of multiple sinuses. Treatment of choice was low-molecular-weight heparin in 69.4% of patients. Factors associated with worse clinical outcomes included head and neck infections, malignancy (other than hematologic), cardiac disease, and recent surgery; seizure and dehydration on initial presentation; motor abnormalities and AMS on initial examination; ischemic infarct only; and involvement of vein of Trolard on neuroimaging. Thrombus condition on repeat imaging, receiving any anticoagulant/antithrombotic treatment, treatment duration, or follow-up duration was not associated with severity of long-term outcome. CSVT may lead to unfavorable long-term outcomes in a remarkable portion of pediatric patients. Thus, a high index of suspicion and early and appropriate management of pediatric CSVT is imperative.