Cerebral Sinovenous Thrombosis in the Neonate

Abstract

Background: There are few studies on neonatal cerebral sinovenous thrombosis (SVT). Objectives: To describe the presentations, treatments, and outcomes of neonatal SVT and to assess infarction as a predictor of outcome. Design: Retrospective chart study. Setting: 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. Interventions: None. Main Outcome Measures: 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. Twentyfive (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.

Antithrombotic Therapy in Neonates and Children

“…50%, of which the majority are hemorrhagic. 383,384 IVH is also frequent. Among term neonates with IVH, underlying CSVT is documented in nearly one-third (31%) and is more likely when thalamic hemorrhage is present ( P 5 .03).…”

“…The lesions Reported outcomes after neonatal CSVT include death in 7% to 19% and neurologic impairments in 36% to 79% of survivors. 383,384,386 Adverse neurologic outcomes include cognitive and motor defi cits and in 20% to 40%, epilepsy. 387 The presence of infarcts at diagnosis and perinatal complications predict worse outcome.…”

“…390 There are no RCTs 391 ; however, data on the safety of anticoagulation in neonates with CSVT are available. 378,383,384,392 There are signifi cant geographic differences in physician decisions to treat neonates with CSVT with anticoagulants, with European and Canadian physicians much more likely to treat than US physicians. 392 In a consecutive cohort treatment safety study using standardized protocols for anticoagulation of neonatal CSVT, bleeding occurred in three of 37 (8%) treated neonates but was not fatal in any.…”

Cerebral sinus venous thrombosis in Swiss children

“…[1][2][3][4] Older children often use prothrombotic agents such as oral contraceptives or suffer from infections of the head and neck or a chronic systemic illness.…”

Cerebral sinovenous thrombosis in children – analysis of 5 CSVT cases from Child Neurology Clinic in Rzeszow

“…Wśród noworodków, które przeżyły 36-76% jest obarczonych różnymi deficytami neurologicznymi w tym padaczka występuje u 20-40% [6]. Dostępne są badania potwierdzające bezpieczeństwo stosowania heparyn u noworodków [9,10,11,12]. Opisywane są powikłania krwotoczne do jam ciała po zastosowaniu heparyny niefrakcjonowanej, dlatego najczęściej wybieraną formą leczenia przeciwzakrzepowego u noworodków jest zastosowanie heparyn drobnocząsteczkowych [6].…”