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Cerebral venous sinus thrombosis: a case series including thrombolysis

A A Mallick1, P M Sharples, S E Calvert

  • 1Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK.

Archives of Disease in Childhood
|June 27, 2009
PubMed

Insights

Cerebral venous sinus thrombosis (CVST) in children presents variably and carries significant risks. While heparin is standard, local thrombolysis showed promise in severe cases, though more evidence is needed for routine use.

Area of Science:

  • Pediatric Neurology
  • Vascular Neurology
  • Pediatric Critical Care

Background:

  • Cerebral venous sinus thrombosis (CVST) in children presents with diverse symptoms, posing diagnostic challenges.
  • CVST is linked to high rates of severe morbidity and mortality in pediatric populations.
  • Optimal treatment strategies for pediatric CVST remain uncertain.

Purpose of the Study:

  • To characterize the clinical features of pediatric CVST cases treated at a specialized center.
  • To evaluate the efficacy and safety of local thrombolysis as an adjunct treatment for severe pediatric CVST.

Main Methods:

  • Systematic electronic database searches using diagnostic labels and ICD codes.
  • Retrospective review of medical records for pediatric patients (1 month to <17 years) diagnosed with CVST.
  • Analysis of presenting symptoms, clinical signs, underlying conditions, treatments, and outcomes.

Main Results:

  • Twenty-one pediatric CVST cases were identified over 8.25 years, with a median age of 7.1 years.
  • Common symptoms included headache, vomiting, and visual disturbances; papilledema was a frequent sign.
  • Middle ear infection was the most common associated condition; 48% of patients experienced adverse outcomes despite heparin treatment.

Conclusions:

  • Pediatric CVST exhibits non-specific symptoms and carries a substantial risk of neurological sequelae.
  • Heparin is the primary treatment, but local thrombolysis may offer benefits in select severe cases.
  • Further research is required to establish the routine role of thrombolysis in pediatric CVST management.
Abstract

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