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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Evaluation of cases with cerebral thrombosis in children
Olcay Ünver1, Gazanfer Ekinci2, Büşra Işın Kutlubay1
1Division of Pediatric Neurology, Department of Pediatrics, Marmara University School of Medicine, İstanbul, Turkey.
Insights
Cerebral sinovenous thrombosis (CSVT) is a serious condition often presenting with headache. Early diagnosis and investigation of causes like mastoiditis and genetic factors are crucial for favorable outcomes in pediatric patients.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Cerebral sinovenous thrombosis (CSVT) is a rare but serious condition in children.
- Diagnosis can be challenging due to varied clinical presentations.
Purpose of the Study:
- To evaluate pediatric patients diagnosed with CSVT.
- To analyze age, sex, clinical findings, etiology, thrombophilic factors, imaging, treatment, and prognosis.
Main Methods:
- Retrospective analysis of 11 pediatric patients diagnosed with CSVT between 2010 and 2014.
- Review of clinical files, including etiology, thrombophilia, imaging, and treatment outcomes.
Main Results:
- The study included 7 male patients (63.6%) with a median age of 14 years.
- Headache was the most common symptom (54%), followed by diplopia, weakness, speech difficulty, and seizures.
- Common etiologies included pseudotumor cerebri (72.7%), mastoiditis, Behçet's disease, and head trauma. Thrombophilic factors such as protein C/S deficiency and Factor V Leiden mutation were identified.
Conclusions:
- CSVT should be considered in children presenting with headache and focal neurological deficits.
- Imaging studies are essential for diagnosis, and ENT examinations are important to identify mastoiditis.
- Investigating genetic risk factors and considering conditions like Behçet's disease in the differential diagnosis is recommended for pediatric CSVT.
Aim:
We aimed to evaluate the patients who were followed up in our clinic with a diagnosis of cerebral sinovenous thrombosis in terms of age, sex, clinical findings, etiology, thrombophilic factors, imaging findings, treatment and prognosis.
Material And Methods:
The files of 11 patients who were followed up in our pediatric neurology clinic with a diagnosis of cerebral thrombosis between 1 December 2010 and 31 December 2014 were retrospectively analyzed.
Results:
Seven of 11 patients were male (63.6%). The median age was 14 years (2-17 years). Six (54%) of the patients presented with a complaint of headache. Other complaints at presentation included diplopia (n:3), weakness and difficulty in speaking (n:1) and seizure (n:1). A diagnosis of pseudotumor cerebri was made in eight of the patients (72.7%). In the etiology, mastoiditis was found in three patients, mastoiditis and meningitis were found in combination in one patient, Behçet's disease was found in three patients and head trauma was found in one patient. In 3 patients, only prothrombotic genetic risk factors were present; one patient had deficiency of protein C and S, one patient had deficiency of antithrombin III and one patient had hyperhomosisteinemia in association with vitamin B12 deficiency. 1A homozygous MTFHR A1298C mutation was detected in the patient who had mastoiditis and meningitis and protein S deficiency and lupus anticoagulant were found in another patient who had mastoiditis. All patients received anticoagulant treatment and all patients recovered without neurological sequelae except one.
Conclusions:
Cerebral sinovenous thrombosis should be considered in patients who present with headache and focal neurological deficits. Appropriate utilization of imaging studies is necessary for the diagnosis. Detailed ear, nose and throat examination should be performed to detect mastoiditis. It is recommended that genetic risk factors should be investigated, because hereditary thrombophilis factors may have a role in children. Behçet's disease which is relatively common in our country should be considered in differential diagnosis.
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