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Cerebral Venous Sinus Thrombosis in Preterm Infants
Rhandi Christensen1, Pradeep Krishnan2, Gabrielle deVeber1,3
1Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto' Ontario' Canada (R.C., G.d., N.D., D.M., E.P., M.M.).
Stroke
|April 18, 2022
Summary
Neonatal cerebral venous sinus thrombosis (CVST) in preterm infants often causes white matter brain lesions. Anticoagulation treatment in this small cohort appeared safe, though further research is needed.
Area of Science:
- Neonatology
- Neurology
- Pediatric Stroke
Background:
- Neonatal cerebral venous sinus thrombosis (CVST) can cause significant brain injury and neurodevelopmental issues.
- Existing research on neonatal CVST primarily focuses on term infants, with limited data on preterm infants.
- This study addresses the gap by investigating CVST specifically in preterm infants.
Purpose of the Study:
- To examine the clinical and radiological features of CVST in preterm infants.
- To evaluate the treatment strategies and outcomes for CVST in this vulnerable population.
- To provide insights into the management and prognosis of preterm neonatal CVST.
Main Methods:
- A retrospective cohort study of preterm infants (gestational age <37 weeks) with confirmed CVST.
- Re-evaluation of MRI/MRV and CT/CTV scans to analyze thrombus characteristics and brain injury patterns.
- Outcome assessment using a validated pediatric stroke outcome measure at follow-up.
Main Results:
- Twenty-six preterm infants were studied, with most being moderate-late preterm.
- Commonly affected sinuses included transverse (85%) and superior sagittal (42%).
- White matter injury (periventricular and deep) predominated (35% and 31%), with 46% experiencing intraventricular hemorrhage. Anticoagulation was used in 69% of infants, with no new hemorrhages reported post-treatment. Fifty percent had no neurological deficits at follow-up.
Conclusions:
- A significant proportion of preterm infants with CVST were asymptomatic.
- White matter lesions were the predominant brain injury, and half experienced neurological deficits.
- Anticoagulation appears safe for preterm CVST, but larger studies are necessary.
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