Cerebral sinovenous thrombosis in children: A single-center experience

Abstract

Objective: The study aimed to evaluate the patients with a diagnosis of cerebral sinovenous thrombosis in terms of clinical findings, etiology and underlying risk factors, imaging findings, treatment, and prognosis in the long term.

Materials and methods: Medical records of 19 patients whose ages ranged between 0 days and 17 years with clinical and radiological cerebral sinovenous thrombosis in Ege University Department of Child Neurology were retrospectively evaluated.

Results: Nine of nineteen cases were female (47.3%). The median age was 84 months (0-201 months). The most common complaint at the presentation was headache (n=12) and the most common physical examination finding was papilledema (n=11). In etiology, otitis/mastoiditis in three cases, iron deficiency anemia in three cases, sinusitis in two cases, catheter use in four cases, Behçet's disease in three cases were determined. The most common observed genetic factors causing thrombosis was methylenetetrahydrofolate reductase mutation. The transverse sinus (68.4%) is the sinus where thrombosis is most frequently observed. As a result of an average follow-up of 12 months (2-72 months), hemiparesis (n=3/19, 15.7%) and epilepsy (n=5/19, 26.3%) were recorded as sequelae findings, and no mortality was observed.

Conclusion: In cases presenting with headache, evaluation of papilledema on funduscopic examination should not be skipped. Neurological imaging should be performed in the change of consciousness of poor feeding infants and children with infections in the head and neck area or underlying chronic diseases. When cerebral sinovenous thrombosis is detected, anticoagulant therapy should be started immediately.

Keywords: Cerebral sinovenous thrombosis; neuroimaging; pediatric stroke; treatment.

Figure 1. a, b

A 12-years-old male with ALL who presented with headache and drowsiness after L-asparaginase treatment (Case 13) (a) A1- coronal, A2-axial, A3- sagittal T1-weighted Cranial MR and MR venography with filling defects compatible with thrombosis of the superior sagittal sinus, right transverse sinus and sigmoid sinus in acute phase and sinus enlargement (arrow) (b) B1-coronal, B2-axial, B3-sagittal at the 1st month control MR venography showed thinning of the thrombus and recanalization in superior sagittal sinus, right transverse sinus, right sigmoidal sinus

Figure 2. a, b

0-day-old girl, has ventriculoperitoneal shunt operation due to hydrocephalus secondary to antenatal intracranial hemorrhage (Case 2) (a) A1 coronal, A2 axial The enlargement and thrombosis in bilateral transverse sinus, sigmoid sinus and sinus rectus (arrowhead) also; periventricular germinal matrix hemorrhage and hemorrhage of the lateral ventricles at the level of the basal ganglia in T2-weighted sequences MR venography (arrow) (b) B1 coronal, B2 axial at the 3rd month control MR venography, partially recanalized thrombi defined in bilateral transverse sinus and sigmoid sinus, asymmetric dilatation of lateral ventricules; thinning of right lateral ventricle and enlargement of the left lateral ventricle