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Diagnosis and management of cerebral venous sinus thrombosis in children: a single-center retrospective analysis

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Abstract

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.

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Abbreviations

ATIII:

Antithrombin III

CTV:

Computed tomography venography

CVT:

Cerebral venous thrombosis

INR:

International normalized ratio

IQR:

Interquartile range

LMWH:

Low molecular weight heparin

MRI:

Magnetic resonance imaging

MRV:

Magnetic resonance venography

PICU:

Pediatric intensive care unit

TTR:

Target therapeutic range

UFH:

Unfractionated heparin

VKAs:

Vitamin K antagonists

VTE:

Venous thrombosis

Xa:

Activated factor X

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Authors and Affiliations

  1. Dipartimento di Pediatria, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy

    Ilaria Lazzareschi, Antonietta Curatola & Piero Valentini

  2. Dipartimento di Pediatria, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    Antonio Gatto

  3. Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy

    Filomena Maellaro

  4. Dipartimento di Neurochirurgia Infantile, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    Paolo Frassanito

  5. Servizio di Malattie Emorragiche e Trombotiche, Area di Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    Maria Basso & Raimondo De Cristofaro

  6. Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy

    Raimondo De Cristofaro

Authors
  1. Ilaria Lazzareschi
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  2. Antonietta Curatola
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  3. Antonio Gatto
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  4. Filomena Maellaro
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  5. Paolo Frassanito
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  6. Maria Basso
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  7. Raimondo De Cristofaro
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  8. Piero Valentini
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Corresponding author

Correspondence to Antonietta Curatola.

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This study was approved by the Institutional Review Board and Ethic Committee of our institution.

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All subjects gave their consent to participate in the study.

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All subjects gave their consent to the publication of anonymized data.

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Lazzareschi, I., Curatola, A., Gatto, A. et al. Diagnosis and management of cerebral venous sinus thrombosis in children: a single-center retrospective analysis. Childs Nerv Syst 37, 153–160 (2021). https://doi.org/10.1007/s00381-020-04958-z

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  • DOI: https://doi.org/10.1007/s00381-020-04958-z

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