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

Tekşam, Mehmet; Moharir, Mahendranath; deVeber, Gabrielle; Shroff, Manohar

doi:10.3174/ajnr.a1246

Cited by 81 publications

(70 citation statements)

References 13 publications

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“…Because we focused on infants with an associated thalamic hemorrhage, it is not unexpected that thrombosis of the straight sinus was more often diagnosed than in previous studies about CSVT. 2,4,9,22,23 In our cohort, we found a male predominance, consistent with previous studies. 4,24 In agreement with the 2 largest studies reported so far, those from deVeber and colleagues 2 and Fitzgerald and colleagues, 4 perinatal complications and perinatal asphyxia were frequent findings in our patients.…”

Section: Kersbergen Et Al Therapy In Neonates With a Thalamic Hemorrhsupporting

confidence: 92%

Anticoagulation Therapy and Imaging in Neonates With a Unilateral Thalamic Hemorrhage Due to Cerebral Sinovenous Thrombosis

Kersbergen

Vries

Straaten

et al. 2009

Stroke

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Background and Purpose— 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.

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Section: Kersbergen Et Al Therapy In Neonates With a Thalamic Hemorrhsupporting

confidence: 92%

Anticoagulation Therapy and Imaging in Neonates With a Unilateral Thalamic Hemorrhage Due to Cerebral Sinovenous Thrombosis

Kersbergen

Vries

Straaten

et al. 2009

Stroke

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“…The deep venous system, particularly the straight sinus, was more commonly involved in neonates than previously reported. 1,4,5,11 We do not have a satisfactory explanation for this finding. The risk factors for CSVT in neonates and children were similar to previous findings.…”

Section: Discussionmentioning

confidence: 76%

“…1,6,10 Parenchymal injuries, such as ischaemic or haemorrhagic infarcts, are often observed in conjunction with CSVT. [1][2][3]11,12 One-third of term neonates with intraventricular haemorrhage suffer from CSVT. 13 Two to 10 per cent of the neonates 2,4 and 11 to 17% of the older children died after CSVT 2,6 .…”

mentioning

confidence: 99%

Cerebral sinus venous thrombosis in Swiss children

Grunt

Wingeier

Wehrli

et al. 2010

Develop Med Child Neuro

104

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AIM To describe the characteristics of paediatric cerebral sinus venous thrombosis (CSVT) inSwitzerland.METHOD Data on clinical features, neuroimaging, risk factors, and treatment were collected for all children in Switzerland younger than 16 years of age who had CSVT between January 2000 and December 2008. A follow-up examination and a cognitive assessment were performed (mean follow-up period 26mo). Differences between neonates and children (patients older than 28d) were assessed and predictors of outcome were determined.RESULTS Twenty-one neonates (14 males, seven females; mean age 9d, SD 8d) and 44 children (30 males, 14 females; mean age 8y 7mo, SD 4y 5mo) were reported. The incidence of paediatric CSVT in Switzerland was 0.558 per 100 000 per year. In neonates, the deep venous system was more often involved and parenchymal injuries were more common. The strongest predictor of poor outcome was neonatal age (odds ratio 17.8, 95% confidence interval 0. 847-372.353). Most children showed global cognitive abilities within the normal range, but impairments in single cognitive subdomains were frequent.INTERPRETATION Paediatric CSVT is rare. Its outcome is poor in neonates. Most children have good neurological outcomes, but some patients have individual neuropsychological impairments.Cerebral sinus venous thrombosis (CSVT) in children is rare. Based on a Canadian registry, its incidence is 0.67 cases per 100 000 children per year; neonates were the most commonly affected.1 The risk factors in neonates include maternal conditions, delivery complications, and neonatal comorbidities. [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.5-8 Prothrombotic states are increased in patients who suffer from CSVT.1,9 The superficial venous system is most commonly involved. 1,6,10 Parenchymal injuries, such as ischaemic or haemorrhagic infarcts, are often observed in conjunction with CSVT. [1][2][3]11,12 One-third of term neonates with intraventricular haemorrhage suffer from CSVT. 13Two to 10 per cent of the neonates 2,4 and 11 to 17% of the older children died after CSVT 2,6 . A recurrence of the thrombosis occurred in 6%.10 Thirty-eight per cent of the patients exhibited neurological deficits, such as motor impairment, cognitive problems, or epilepsy.1 The long-term outcome was especially poor in neonates. 1,2,4 In older children who suffered from CSVT, cognitive assessments with standardized and agenormalized tests showed cognitive performance within the normal range, 14,15 but individual impairments were seen in up to 20% of the patients. 14In the present study, we aimed to describe the incidence, clinical manifestation, neuroimaging findings, risk factors, and treatment of children suffering from CSVT in Switzerland. In addition, we systematically assessed outcomes after CSVT and identified predictors of poor outcome. METHOD Participants and data collectionThe Swiss Neuropaediatric Stroke Registry (SNPSR) is a...

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“…5 The study by Teksam et al demonstrated that commonest sites of CSVT are the transverse, superior sagittal, sigmoid, and straight sinuses. 6 Our patient had involvement of transverse and superior sagittal sinus.…”

Section: Discussionmentioning

confidence: 65%

“…This is an autosomal recessive condition and the gene involved is localized to 21q22.3. About 40% of affected patients respond to high doses of Vitamin B 6 and usually have milder clinical manifestations than those unresponsive to Vitamin B 6 therapy. Our patient had mental subnormality as the only feature of this condition.…”

Section: Discussionmentioning

confidence: 99%