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Cerebral Venous Thrombosis in Pediatric Age: Risk Factors and Prognosis
Inês Pais-Cunha1, Ana I Almeida2, Ana R Curval1
1Serviço de Pediatria, Unidade Autónoma Gestão da Mulher e da Criança, Centro Hospitalar Universitário de São João, Porto, Portugal.
Insights
Pediatric cerebral venous thrombosis (CVT) risk factors like permanent conditions and sinus involvement predict severe outcomes. Early detection and management of these factors are crucial for reducing pediatric CVT morbidity and mortality.
Area of Science:
- Pediatric Neurology
- Vascular Neurology
- Pediatric Critical Care
Background:
- Cerebral venous thrombosis (CVT) is a rare but serious condition in children.
- Limited research exists on risk factors and long-term outcomes in pediatric CVT compared to adults.
Purpose of the Study:
- To identify risk factors associated with clinical manifestations in pediatric CVT.
- To determine factors linked to long-term sequelae in children with CVT.
Main Methods:
- Retrospective analysis of pediatric patients diagnosed with CVT.
- Data collected from a tertiary-care hospital between 2008 and 2020.
- Inclusion of 54 pediatric inpatients.
Main Results:
- Permanent risk factors (e.g., malignancy) and transient factors (e.g., infections) were identified.
- Multiple venous sinus involvement (65%) and deep venous system involvement were noted.
- Intracranial hemorrhage (17%) and cerebral infarction (9%) were observed.
- Permanent risk factors correlated with severe manifestations (p=0.043).
- Cerebral infarction and hemorrhage were associated with major sequelae (p=0.006 and p=0.03).
Conclusions:
- Permanent risk factors, multiple sinus involvement, intracranial hemorrhage, and cerebral infarction predict a worse prognosis in pediatric CVT.
- Early identification and management of risk factors are essential to mitigate CVT severity and improve outcomes.
Introduction:
Cerebral venous thrombosis (CVT) is a rare but potentially fatal disease in pediatric age with an important morbimortality. In adults several factors have been associated with worse outcomes, however there are still few studies in children. This study aims to identify risk factors associated with clinical manifestations and long-term sequelae in pediatric CVT.
Methods:
Retrospective analysis of pediatric inpatients admitted to a tertiary-care hospital due to CVT between 2008 and 2020.
Results:
Fifty-four children were included, 56% male, median age of 6.5 years (9 months-17.3 years). Permanent risk factors were identified in 13 patients (malignancy, 8; hematologic condition, 5) and transient risk factors in 47, including head and neck infections (57%) and head trauma (15%). Multiple venous sinuses involvement was present in 65% and the deep venous system was affected in four patients. Seventeen percent had intracranial hemorrhage and 9% cerebral infarction. Sixty-four percent of patients with multiple venous sinuses involvement presented with severe clinical manifestations: impaired consciousness, intracranial hypertension, acute symptomatic seizures or focal deficits. Regarding long-term prognosis, six patients had major sequelae: epilepsy (n = 3), sensory motor deficits (n = 2), and cognitive impairment (n = 3). Permanent risk factors were associated with severe clinical manifestations (p = 0.043). Cerebral infarction and intracranial hemorrhage were associated with major sequelae (p = 0.006 and p = 0.03, respectively, adjusted for age and sex).
Conclusion:
Permanent risk factors, involvement of multiple venous sinuses, intracranial hemorrhage, and cerebral infarction, were related to worse prognosis. Detection and early management of risk factors may limit CVT extension and reduce its morbimortality.
