Clinical Diversity of Cerebral Sinovenous Thrombosis and Arterial Ischaemic Stroke in the Neonate: A Surveillance Study

Abstract

<b><i>Introduction:</i></b> Relative risk, risk factors, clinical presentation, onset of symptoms, and age at diagnosis differ between arterial ischaemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) in neonates. Distinguishing these 2 entities in time clinically can be of eminent importance. <b><i>Methods:</i></b> Active surveillance for AIS and CSVT was performed in 345 German paediatric hospitals. Only cases confirmed by cerebral MRI were included in our analysis. Patients with AIS were compared to CSVT cases with regard to age at diagnosis, pattern of clinical symptoms, and risk factors. <b><i>Results:</i></b> Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The relative risk of AIS was 2.8 (95% CI 2.1; 3.9) times higher than that of CSVT. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; <i>p</i> = 0.02) and to have signs of perinatal acidosis (e.g., umbilical artery pH ≤ 7.1 30.2% CSVT vs. 13.5% AIS <i>p</i> = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (<i>p</i> < 0.0001). Age at onset of symptoms and at time of diagnoses was shifted to older ages in CSVT (<i>p</i> < 0.0001). <b><i>Discussion/Conclusion:</i></b> The risk for AIS is about 3 times higher than that for CSVT in neonates. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal risk factors are more important for CSVT than for AIS. The data underline the need for an increased awareness of CSVT in critically ill infants.

Neonatal Cerebral Sinovenous Thrombosis and the Main Perinatal Risk Factors—A Retrospective Unicentric Study

“…Besides thrombophilia mutations, other maternal and neonatal risk factors have been cited as important contributors to the development of cerebral venous thrombosis. The univariate analysis of a nested case–control study revealed that male sex, preterm birth, hypoxia, and related indicators (umbilical artery pH < 7.1; 5 min Apgar score < 7; intubation/mask ventilation; perinatal asphyxia) were significantly associated with neonatal cerebral sinovenous thrombosis [ 18 ]. The majority of our patients were males, born through vaginal delivery, and had a mean Apgar score at 5 min and SD of 6 ± 2.3 (range: 2–8; 95% CI: 4.19–7.80).…”

“…The clinical manifestations in neonates are often subtle and nonspecific, especially at the presentation, and include seizures, lethargy, irritability, poor feeding, or changes in muscle tone [ 17 , 18 ]. The CSVT-associated intracranial hypertension syndrome is a medical emergency, which can lead to brain tissue herniation and death [ 19 ].…”

Biomarker und Neuromonitoring zur Entwicklungsprognose nach perinataler Hirnschädigung

“…Durch den gezielten Einsatz von Schallköpfen mit höherer Frequenz lässt sich die diagnostische Aussagekraft erhöhen [ 24 ]. Die Doppler-cUS erlaubt Aussagen zur intrazerebralen Perfusion und wird zur Diagnostik von arteriellen und venösen Ischämien in der Neonatalperiode eingesetzt [ 72 , 88 ].…”

“…In der initialen Diagnostik des neonatalen arteriell-ischämischen Schlaganfalls, der Sinusvenenthrombose [ 88 ], von neonatalen Infektionen und Hirnfehlbildungen ist die MRT nicht mehr wegzudenken. Darüber hinaus ist sie aufgrund der besseren Darstellung von strukturellen Auffälligkeiten ein wertvolles Instrument in der klinischen Routinediagnostik unklarer neurologischer Symptome beim Neonaten, wie z.…”

“…Darüber hinaus gibt es weitere perinatale Hirnschädigungen, deren Ursachen oft unklar bleiben. Dazu zählen die Asphyxie, schwere Infektionen und Inflammation, arteriell-ischämische Schlaganfälle, Sinusvenenthrombosen, periventrikuläre venöse Infarkte, Hirnschädigungen durch Hypoglykämie und intrazerebrale Blutungen mit Komplikationen wie posthämorrhagische Ventrikelerweiterung oder Shunt-pflichtiger Hydrozephalus [ 33 , 84 , 88 ]. Für die Mehrzahl dieser Erkrankungen gibt es bisher keine kausale Therapie, daher stehen nur präventive und supportive Maßnahmen zur Verfügung.…”