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Cavernous Sinus Thrombosis in Children: Imaging Characteristics and Clinical Outcomes
Craig A Press1, Aaron Lindsay1, Nicholas V Stence1
1From the Departments of Pediatric Neurology (C.A.P., T.J.B.) and Radiology (A.L., N.V.S., L.Z.F., D.M.M.), Children's Hospital Colorado, University of Colorado Denver, Aurora.
Insights
Cavernous sinus thrombosis (CST) in children frequently causes carotid artery narrowing (CAN) and stroke, but outcomes are often favorable with appropriate treatment. This study highlights imaging features and treatment outcomes in pediatric CST.
Area of Science:
- Pediatric Neurology
- Cerebrovascular Diseases
- Medical Imaging
Background:
- Cavernous sinus thrombosis (CST) is a rare, life-threatening cerebrovascular condition.
- CST can lead to carotid artery narrowing (CAN) and ischemic stroke, with limited data in children.
Purpose of the Study:
- To describe the clinical presentation, imaging findings, and treatment outcomes of CST in children.
- To characterize the association between CST, CAN, and stroke in pediatric patients.
Main Methods:
- Retrospective review of pediatric patients with imaging-confirmed CST from 2003 to 2014.
- Analysis of presenting symptoms, imaging features, treatment strategies, and patient outcomes.
Main Results:
- Ten pediatric patients with CST were identified, all exhibiting CAN; 60% developed infarcts.
- Common imaging findings included cavernous sinus expansion, filling defects, and venous/orbital inflammation.
- Anticoagulation was used in 8 patients, with favorable outcomes and a modified Rankin Scale score of ≤1 in 70%.
Conclusions:
- Carotid artery narrowing and infarcts are frequent complications of pediatric CST.
- Despite complications, outcomes in childhood CST can be favorable, with potential for CAN resolution.
- Larger multicenter studies are needed to confirm findings and optimize therapeutic strategies for pediatric CST.
Background And Purpose:
Cavernous sinus thrombosis (CST) is a rare life-threatening cerebrovascular disease known to cause carotid artery narrowing (CAN) and arterial ischemic stroke. The imaging features of CST and related complications have been reported in adults, but rarely in children.
Methods:
We performed a retrospective review of children with imaging confirmed CST from 2003 to 2014, describing presenting symptoms, imaging findings, and treatment.
Results:
Ten patients with CST were identified. All had CAN and 6 of 10 developed infarcts. Of 8 patients treated with anticoagulation therapy, 3 developed new infarcts. None required discontinuation of anticoagulation therapy because of bleeding. Visual impairment secondary to infectious neuritis was common. Imaging characteristics include cavernous sinus expansion, filling defects, restricted diffusion, arterial wall enhancement, empyema, superior ophthalmic vein enlargement and thrombosis, orbital cellulitis, and pituitary inflammation. CAN resolved in 60% of cases. Outcomes were mostly good, with a modified Rankin Scale score of ≤1 for 7 of 10 patients at discharge and 1 death.
Conclusions:
CAN and infarcts were common in this modest cohort of children with CST. Despite the high incidence of CAN and infarction, outcomes were often favorable. Although this is the largest cohort of childhood CST reported to date, large multicenter cohorts are needed to confirm our findings and determine the preferred therapeutic strategies for childhood CST.
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