Pediatric cavernous sinus thrombosis

Smith, Douglas M.; Vossough, Arastoo; Vorona, Gregory; Beslow, Lauren A.; Ichord, Rebecca; Licht, Daniel J.

doi:10.1212/wnl.0000000000001886

Cited by 51 publications

(10 citation statements)

References 22 publications

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“…The explanation of the decline in mortality of CST in the last decades is sought in improved treatment and identification of less serious case by better quality and availability of imaging techniques. Our study thus adds another contemporary series that shows that mortality is not so dramatically anymore, like several recent articles suggested [ 24 , 33 , 34 ]. Lizé et al performed a retrospective study of patients with CST as a complication of sinusitis and reported no deaths among their seven patients [ 24 ].…”

Section: Discussionsupporting

confidence: 71%

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Prognosis of septic cavernous sinus thrombosis remarkably improved: a case series of 12 patients and literature review

Poel

Mourits

Win

et al. 2018

Eur Arch Otorhinolaryngol

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PurposeSeptic cavernous sinus thrombosis (CST) is a rare complication of infections in the head and neck area. CST is notorious for its bad prognosis, with high mortality and morbidity rates described in literature. However, these rates are based on old series. We question whether the prognosis of CST is currently still as devastating. The primary purpose of this study is to assess the mortality and morbidity of CST.MethodsUsing the databases of all relevant specialties in our tertiary referral hospital, we collected all the patients treated for CST in the period 2005–2017. In addition, a PubMed search, using the mesh term ‘cavernous sinus thrombosis’, was performed.ResultsWe found 12 patients with CST in the study period. Of the 12 patients, 11 survived and 9 recovered without any permanent deficits. Seven patients were treated with anticoagulation, and in none of the patients we saw hemorrhagic complications. In literature, older articles describe higher mortality rates (14–80%), but more recent articles report mortality and morbidity rates similar to our results.ConclusionsThe prognosis of CST nowadays is more favorable than previously described. Anticoagulation seems to be a safe addition to antibiotic and surgical treatment, at least in patients without central nervous system infection.

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Section: Discussionsupporting

confidence: 71%

“…They report a mortality of 0% in their own series and 8% in pediatric cases published between 1994 and 2014. Morbidity rates were 25% in both their own patients and in the selected literature [ 33 ]. Wang et al published a case report and literature review on CST caused by sinusitis between 2002 and 2015.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of septic cavernous sinus thrombosis remarkably improved: a case series of 12 patients and literature review

Poel

Mourits

Win

et al. 2018

Eur Arch Otorhinolaryngol

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“…Radiologic confirmation of a diagnosis of cavernous sinus thrombosis has distinct requirements. It is best evaluated with contrast-enhanced brain MRI and will be missed by non-enhanced CT and by non-enhanced MRI and conventional MR venography ( 16 ).…”

Section: Diagnostic Approach: Update On Imaging Options and Best Pracmentioning

confidence: 99%

Cerebral Sinovenous Thrombosis

Ichord

2017

Front. Pediatr.

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Cerebral sinovenous thrombosis (CSVT) is a rare but serious cerebrovascular disorder affecting children from the newborn period through childhood and adolescence. The incidence is estimated at 0.6/100,000/year, with 30–50% occurring in newborns. Causes are diverse and are highly age dependent. Acute systemic illness is the dominant risk factor among newborns. In childhood CSVT, acute infections of the head and neck such as mastoiditis are most common, followed by chronic underlying diseases such as nephrotic syndrome, cancer, and inflammatory bowel disease. Signs and symptoms are also age related. Seizures and altered mental status are the commonest manifestations in newborns. Headache, vomiting, and lethargy, sometimes with 6th nerve palsy, are the most common symptoms in children and adolescents. Recent multicenter cohort studies from North America and Europe have provided updated information on risk factors, clinical presentations, treatment practices, and outcomes. While systemic anticoagulation is the most common specific treatment used, there are wide variations and many uncertainties even among experts concerning best practice. The treatment dilemma is especially pronounced for neonatal CSVT. This is due in part to the higher prevalence of intracranial hemorrhage among newborns on the one hand, and the clear evidence that newborns suffer greater long-term neurologic morbidity on the other hand. With the advent of widespread availability and acceptance of acute endovascular therapy for arterial ischemic stroke, there is renewed interest in this therapy for children with CSVT. Limited published evidence exists regarding the benefits and risks of these invasive therapies. Therefore, the authors of current guidelines advise reserving this therapy for children with progressive and severe disease who have failed optimal medical management. As research focused on childhood cerebrovascular disease continues to grow rapidly, the future prospects for improving knowledge about this disorder should be good.

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“…Morbidity and mortality were low with early aggressive surgical, antimicrobial, and anticoagulation therapies, but outcome was not significantly changed. [ 1 ]…”

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confidence: 99%

“…COMMENTARY. Pediatric cavernous sinus thrombosis (CST) is a rare and life-threatening complication of septic or aseptic etiologies, and is associated with low morbidity and mortality if aggressive therapies including antimicrobials, anticoagulation, and/or surgical treatment are implemented early on [ 1 ]. CST is associated with neurologic disability if not detected in a timely manner.…”

mentioning

confidence: 99%