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Cerebral Venous Sinus Thrombosis in Children: A Study from a Tertiary Care Hospital of Eastern India
Shubhankar Mishra1, Ashok K Mallick1, Geeta Mohanty1
1Department of Neurology, Srirama Chandra Bhanja Medical College & Hospital (SCBMCH), Cuttack, Odisha, India.
Insights
Childhood cerebral venous sinus thrombosis (CVST) is an underdiagnosed condition, often linked to infections. Early diagnosis and management are crucial for preventing severe outcomes in children.
Area of Science:
- Pediatric Neurology
- Neuroimaging
- Vascular Neurology
Background:
- Childhood cerebral venous sinus thrombosis (CVST) is a rare but significant neurological disorder.
- It has a high rate of neurological sequelae (40%) and mortality (10%).
- CVST is often multifactorial in etiology.
Purpose of the Study:
- To identify pediatric patients diagnosed with CVST.
- To determine the etiological factors and radiological findings in these patients.
- To correlate clinical presentation with radiological evidence of CVST.
Main Methods:
- Prospective clinical study conducted over 2 years.
- Inclusion of patients younger than 14 years diagnosed with CVST.
- Detailed clinico-radiological evaluation and analysis of outcomes after 3 months.
Main Results:
- 30 pediatric patients were included, with 6 neonates.
- Tuberculous meningitis was the most common provocative factor.
- Neonatal hyperbilirubinemia treated with phototherapy was a significant cause in neonates; multiple sinus and transverse sinus involvement were common.
Conclusions:
- CVST is an underdiagnosed cause of childhood stroke, particularly in neonates.
- Infections and hypercoagulable disorders are primary associations.
- Early diagnosis via MRI venography and prompt management are vital for preventing severe consequences.
Context:
Cerebral venous sinus (sinovenous) thrombosis (CVST) in childhood is a rare, but under recognized, disorder, typically of multifactorial etiology, with neurologic sequelae apparent in up to 40% of survivors and mortality approaching 10%.
Aim:
The aim of this study was to enlist the patients diagnosed as CVST younger than 14 years of age and to diagnose the etiology along with radiological correlation.
Settings And Design:
This prospective clinical study was conducted for 2 years in the Department of Neurology, Srirama Chandra Bhanja Medical College & Hospital (SCBMCH), Cuttack, Odisha, India.
Materials And Methods:
All the patients were enlisted in a prestructured format with detailed clinico-radiological evaluation. Treatment was performed according to recent guidelines. Outcome after 3 months was analyzed. Ethical clearance was obtained from institutional ethics committee.
Statistical Analysis:
Data were statistically analyzed using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA).
Results:
The total number of patients included in the study was 30. Of them, six were neonates. The most common provocative factor was tuberculous meningitis. Phototherapy after neonatal hyperbilirubinemia was prominent cause in neonatal age group. Multiple sinus involvement was seen in most of the patients. Transverse sinus was the most common sinus to be involved.
Conclusion:
CVST is an underdiagnosed but important cause of stroke in childhood, occurring most often in the neonatal period. Mortality and morbidity are significant. Infections hyper coagulative disorders are the two primary associations. Magnetic resonance venography is the investigation of choice. Early diagnosis with management along with plan for secondary prevention can save from catastrophic consequences.
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