Purpose

Cerebral venous thrombosis (CVT) is a rare disease in children, characterized by partial or total occlusion of blood flow in the cerebral venous system. The aim of this study is to describe clinical presentation, neuroimaging features, therapeutic management, and outcome of children with CVT.

Methods

We retrospectively analyzed the data, including clinical manifestations, laboratory data, neurological findings, and treatment of children with radiologically confirmed CVT, admitted between January 2010 and March 2020 to our hospital. Cases of CVT complicating brain surgery were excluded.

Results

We enrolled 24 children with CVT. Infection was the main etiology (58.3%), followed by trauma in 16.7% of cases. In the remaining 25% of cases, the cause was identified only in one patient presenting a thrombophilic factor. The most frequent site of thrombosis was the superficial venous system (86.8%), with multiple localizations disclosed in 79% of patients. All children received anticoagulant therapy with low molecular weight heparin (LMWH). One patient died for systemic complications of an underlying disease. No patient developed hemorrhagic events during the therapy, lasting from 35 to 360 days (mean 86 days). In all but one surviving patients (22 out of 24), recanalization of the sinus was observed at AngioMRI performed during follow-up. No neurological complications of CVT were recorded (mean follow-up: 1.5 year).

Conclusions

CVT may present with subtle and unspecific clinical manifestations in children. High level of suspicion should be kept in trauma and sinusitis. Anticoagulation treatment is safe and effective and should be promptly started to improve outcome.

中文翻译：

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儿童脑静脉窦血栓形成的诊断和治疗：一项单中心回顾性分析

目的

脑静脉血栓形成（CVT）是儿童罕见的疾病，其特征是脑静脉系统的血流部分或全部阻塞。本研究的目的是描述 CVT 儿童的临床表现、神经影像学特征、治疗管理和结果。

方法

我们回顾性分析了2010年1月至2020年3月我院收治的经影像学证实的CVT患儿的临床表现、实验室数据、神经系统表现和治疗情况。排除了脑部手术并发 CVT 的病例。

结果

我们招募了 24 名患有 CVT 的儿童。感染是主要病因（58.3%），其次是外伤，占 16.7%。在其余 25% 的病例中，病因仅在一名出现血栓形成因子的患者中被发现。血栓形成最常见的部位是浅静脉系统（86.8%），79% 的患者发现有多个部位。所有儿童均接受低分子肝素（LMWH）抗凝治疗。一名患者死于潜在疾病的全身并发症。治疗期间没有患者发生出血事件，持续时间为 35 至 360 天（平均 86 天）。除了一名幸存的患者（24 名中的 22 名），在随访期间进行的血管磁共振成像中观察到鼻窦再通。没有记录到 CVT 的神经系统并发症（平均随访时间：1.5 年）。

结论

CVT 可能在儿童中出现微妙和非特异性的临床表现。对创伤和鼻窦炎应保持高度怀疑。抗凝治疗安全有效，应及时启动以改善预后。