Cerebral Venous Thrombosis in Children

Heller, Christine; Heinecke, Achim; Junker, Ralf; Knöfler, Ralf; Kosch, Andrea; Kurnik, Karin; Schobeß, R.; Eckardstein, Arnold von; Sträter, Ronald; Zieger, Barbara; Nowak‐Göttl, Ulrike

doi:10.1161/01.cir.0000087598.05977.45

Cited by 276 publications

(198 citation statements)

References 46 publications

(47 reference statements)

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“…The SSS and transverse sinus were more frequently involved in our patient population, which is similar to other studies in the literature. 1,8,9 Anatomic studies with use of postmortem vascular injections have made extensive contributions to our understanding of the cerebral venous drainage system. [10][11][12] The venous drainage of the cerebral hemispheres is divided into the superficial and the deep systems.…”

Section: Discussionmentioning

confidence: 99%

Frequency and Topographic Distribution of Brain Lesions in Pediatric Cerebral Venous Thrombosis

Tekşam¹,

Moharir²,

deVeber³

et al. 2008

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Frequency and Topographic Distribution of Brain Lesions in Pediatric Cerebral Venous Thrombosis

Tekşam¹,

Moharir²,

deVeber³

et al. 2008

AJNR Am J Neuroradiol

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“…Head and neck infections and chronic systemic illnesses usually affect older children, whereas perinatal complications and dehydration affect mostly neonates. 23,59,71 Heller et al 40 emphasized the combination of a prothrombotic state and/or an underlying clinical condition as crucial factors for the development of CVST in children.…”

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confidence: 99%

Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

Filippidis¹,

Kapsalaki

Patramani

et al. 2009

FOC

120

160

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Cerebral venous sinus thrombosis (CVST) is a rare clinicopathological entity. The incidence of CVST in children and neonates has been reported to be as high as 7 cases per million people, whereas in adults the incidence is 3–4 cases per million. The predisposing factors to this condition are mainly genetic and acquired prothrombotic states and infection. The clinical picture of CVST is nonspecific, highly variable, and can mimic several other clinical conditions. Diagnosis of CVST is established with the implementation of neuroimaging studies, especially MR imaging and venography. Identification and elimination of the underlying cause, anticoagulation, proper management of intracranial hypertension, and anticonvulsant prophylaxis constitute cornerstones of CVST treatment. Newer treatment strategies such as endovascular thrombolysis and decompressive craniectomy have been recently used in the treatment of patients with CVST with variable success rates. Further clinical research must be performed to delineate the exact role of these newer treatments in the management of severe cases of CVST. The recent advances in the diagnosis and treatment of patients with CVST have significantly lowered the associated mortality and morbidity and have improved the outcome of these patients.

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“…Of this series, 70% revealed an underlying risk factor for the development of IVT, none of whom had accompanying SDH. 10 Older children and adults with IVT have risk factors such as head trauma as well as hypercoagulable states, which may be genetic (such as Protein C, Protein S, and antithrombin III deficiencies) or due to diseases such as systemic lupus erythematosis, nephrotic syndrome, leukemia, or other malignancies. 6 Spontaneous IVT in adults is also a rare event.…”

mentioning

confidence: 99%

Does Intracranial Venous Thrombosis Cause Subdural Hemorrhage in the Pediatric Population?

McLean

Frasier

Hedlund

2012

AJNR Am J Neuroradiol

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SUMMARY: Unexplained SDH in infants and children is an accepted marker for AHT. It has been proposed that IVT may be the initiating event leading to the development of acute SDH, mimicking the appearance of traumatic SDH. Our study aims to investigate if nontraumatic IVT causes SDH in the pediatric population. We retrospectively identified 36 patients with IVT and reviewed neuroimaging studies for the concurrent presence of SDH. In our 36 patients with IVT, no associated SDH was observed. Even with extensive IVT, no SDH was present. Three false-positive diagnoses of IVT were identified in the setting of mastoiditis and traumatic SDH, demonstrating pitfalls in imaging. In conclusion, our findings do not support the previous AHT literature stating that IVT is associated with, or leads to, SDH in neonates, infants, or children.ABBREVIATIONS: AHT ϭ abusive head trauma; CECT ϭ contrast-enhanced CT; CI ϭ confidence interval; CVT ϭ cortical vein thrombosis; FOV ϭ field of view; GRE ϭ gradient recalled echo; ICV ϭ internal cerebral veins; IVT ϭ intracranial venous thrombosis; MIP ϭ maximum intensity projection; SDH ϭ subdural hematoma/hemorrhage; SPGR ϭ spoiled gradient-recalled; TOF ϭ time-of-flight I VT, which is defined as CVT and/or dural venous sinus thrombosis, is relatively rare in children and young adults. It is often associated with underlying disease states that predispose a patient to a thrombotic event. SDH is also rare in the neonate, infant, and young child, and is usually associated with trauma, infection, thrombogenic states, and less often with other causes.1 IVT occurs with an estimated prevalence of 0.67/100,000 among infants in the first year of life.2 Neonates account for a significant number of pediatric cases. Risk factors for neonatal IVT include polycythemia, other prothrombotic states, and perinatal complications such as head trauma, asphyxia, sepsis, and meningitis. Spontaneous IVT has been described in infants and children, and is frequently due to an underlying condition such as infection, shock, dehydration, hypercoagulable states, iron deficiency anemia, and tumors. 3 However, in a review of the literature, very few cases of IVT were associated with SDH.AHT in neonates, infants, and young children is a complex diagnosis, requiring the interaction of pediatrics, radiology, ophthalmology, and the child protection team. Commonly, young infants present for medical care with unexplained neurologic symptoms, and the diagnosis of a SDH is made based upon imaging. The diagnosis of AHT is then subsequently established through a process that ties medical opinions with history, assessment of other injuries, and investigative results. Patients with AHT may develop IVT as a consequence of intracranial injury. Most such patients also often have other indicators of abusive injury such as fractures, bruises, and retinal hemorrhages. Only recently has IVT been proposed as the initiating event for extra-axial hemorrhage, such as SDH and subarachnoid hemorrhage, in the pediatric population. The theory sugge...

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Cerebral Venous Thrombosis in Children

Cited by 276 publications

References 46 publications

Frequency and Topographic Distribution of Brain Lesions in Pediatric Cerebral Venous Thrombosis

Frequency and Topographic Distribution of Brain Lesions in Pediatric Cerebral Venous Thrombosis

Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

Does Intracranial Venous Thrombosis Cause Subdural Hemorrhage in the Pediatric Population?

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