Paediatric cerebral sinovenous thrombosis: findings of the International Paediatric Stroke Study

Ichord, Rebecca; Benedict, Susan; Chan, Anthony; Kirkham, Fenella J.; Nowak‐Göttl, Ulrike

doi:10.1136/archdischild-2014-306382

Cited by 77 publications

(93 citation statements)

References 18 publications

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“…In the literature, prothombotic factors have been found with a rate of 24-64% in children in the post-neonatal period (1,2,8,(10)(11)(12). Conditions including head and neck traumas and infection (especially sinusitis, mastoiditis, meningitis) are in the first orders in the etiology (18,19,22). In our series, mastoiditis was observed in four patients.…”

Section: Discussionmentioning

confidence: 51%

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Evaluation of cases with cerebral thrombosis in children

et al. 2016

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Aim: We aimed to evaluate the patients who were followed up in our clinic with a diagnosis of cerebral sinovenous thrombosis in terms of age, sex, clinical findings, etiology, thrombophilic factors, imaging findings, treatment and prognosis. Material and Methods:The files of 11 patients who were followed up in our pediatric neurology clinic with a diagnosis of cerebral thrombosis between 1 December 2010 and 31 December 2014 were retrospectively analyzed. Results:Seven of 11 patients were male (63.6%). The median age was 14 years (2-17 years). Six (54%) of the patients presented with a complaint of headache. Other complaints at presentation included diplopia (n:3), weakness and difficulty in speaking (n:1) and seizure (n:1). A diagnosis of pseudotumor cerebri was made in eight of the patients (72.7%). In the etiology, mastoiditis was found in three patients, mastoiditis and meningitis were found in combination in one patient, Behçet's disease was found in three patients and head trauma was found in one patient. In 3 patients, only prothrombotic genetic risk factors were present; one patient had deficiency of protein C and S, one patient had deficiency of antithrombin III and one patient had hyperhomosisteinemia in association with vitamin B12 deficiency. 1A homozygous MTFHR A1298C mutation was detected in the patient who had mastoiditis and meningitis and protein S deficiency and lupus anticoagulant were found in another patient who had mastoiditis. All patients received anticoagulant treatment and all patients recovered without neurological sequelae except one.Conclusions: Cerebral sinovenous thrombosis should be considered in patients who present with headache and focal neurological deficits. Appropriate utilization of imaging studies is necessary for the diagnosis. Detailed ear, nose and throat examination should be performed to detect mastoiditis. It is recommended that genetic risk factors should be investigated, because hereditary thrombophilis factors may have a role in children. Behçet's disease which is relatively common in our country should be considered in differential diagnosis. (Turk Pediatri Ars 2016; 51: 87-93)

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Section: Discussionmentioning

confidence: 51%

“…The median age of occurrence of thrombosis was 14 years. In the literature, the median age has been found to be approximately 2-fold higher according to the studies including patients who were in the post-neonatal period (18,19). The most common cause of presentation was headache.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of cases with cerebral thrombosis in children

et al. 2016

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“…Neurological outcome of CSVT is reportedly poor in those who do not receive anticoagulant therapy so therapeutic anticoagulation is recommended. 20,21 Practice varies in the presence of ICH and the approach is often individualized according to the clinical picture, the extent of ICH, and the presence of additional risk factors for further bleeding. Withholding therapeutic anticoagulation pending reimaging may be appropriate for CSVT in the setting of ICH resulting in intraventricular hemorrhage or mass effect.…”

Section: Discussionmentioning

confidence: 99%

Strategies to Prevent and Manage Thrombotic Complications of Acute Lymphoblastic Leukemia in Children and Young People Vary Between Centers in the United Kingdom

Biss

Payne

Hough

et al. 2016

Journal of Pediatric Hematology/Oncology

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There is a lack of evidence-based guidance for the prevention and management of thrombosis in children and young people treated for acute lymphoblastic leukemia. To determine current UK practice, a survey was sent to 28 centers participating in the Medical Research Council UKALL 2011 trial. Marked variation in practice was noted. In total, 43% of centers defer central venous access device insertion until end of induction for treatment of low-risk disease. Central venous access devices are removed at the end of intensive blocks in 38% and end of treatment in 42%. Duration of anticoagulation for line-associated thrombosis is 6 weeks in 43% and 3 months in 33% and for cerebral sinovenous thrombosis is 3 months in 71% and 6 months in 24%. Platelet transfusion to maintain platelet count >50×10/L, in preference to interrupting therapeutic anticoagulation, is used by 50% for line-associated thrombosis and 73% for cerebral sinovenous thrombosis. Conformity of practice was seen in some areas. In total, 70% treat thrombosis with twice-daily low-molecular weight heparin and 86% monitor antifactor Xa activity levels. In total, 91% reexpose individuals to asparaginase following a thrombotic event. Given this variation in practice, in the absence of high-quality evidence, consensus guidelines may be helpful.

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“…We included all patients with a neurologic deficit of acute onset, and MRI showing an isolated parenchymal infarct conforming to known arterial territory and corresponding to clinical manifestations, experienced between the ages of 29 days and 18 years 14 . To avoid factors possibly confounding the prognosis, we excluded patients with bilateral, multiple, infratentorial or watershed infarcts, previous cerebrovascular disease (including, presumed perinatal stroke and cerebral sinovenous thrombosis 15 ), concomitant hypoxic-ischemic encephalopathy, associated disorder with neurologic impairment at the time of the stroke, and functional impairment before the acute event. This study was approved by the institutional ethics committee and written informed parental consent was obtained.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Could infarct location predict the long-term functional outcome in childhood arterial ischemic stroke?

López-Espejo

Hernández‐Chávez

2017

Arq. Neuro-Psiquiatr.

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Objective: To explore the influence of infarct location on long-term functional outcome following a first-ever arterial ischemic stroke (AIS) in non-neonate children. Method: The MRIs of 39 children with AIS (median age 5.38 years; 36% girls; mean follow-up time 5.87 years) were prospectively evaluated. Infarct location was classified as the absence or presence of subcortical involvement. Functional outcome was measured using the modified Rankin scale (mRS) for children after the follow-up assessment. We utilized multivariate logistic regression models to estimate the odds ratios (ORs) for the outcome while adjusting for age, sex, infarct size and middle cerebral artery territory involvement (significance < 0.05). Results: Both infarcts ≥ 4% of total brain volume (OR 9.92; CI 1.76 – 55.9; p 0.009) and the presence of subcortical involvement (OR 8.36; CI 1.76 – 53.6; p 0.025) independently increased the risk of marked functional impairment (mRS 3 to 5). Conclusion: Infarct extension and location can help predict the extent of disability after childhood AIS.

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Paediatric cerebral sinovenous thrombosis: findings of the International Paediatric Stroke Study

Cited by 77 publications

References 18 publications

Evaluation of cases with cerebral thrombosis in children

Evaluation of cases with cerebral thrombosis in children

Strategies to Prevent and Manage Thrombotic Complications of Acute Lymphoblastic Leukemia in Children and Young People Vary Between Centers in the United Kingdom

Could infarct location predict the long-term functional outcome in childhood arterial ischemic stroke?

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