P355 Cerebral sinovenous thrombosis in children– clinical manifestations, neuroimaging aspects, risk factors, treatment, complications, outcome

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Abstract

Background and aims

Cerebral sinovenous thrombosis (CSVT) are increasingly recognised in children but still underdiagnosed. CSVT in children may be fatal and frequently associated with adverse outcomes.

Methods

Seven children diagnosed with CSVT between March 2012 and November 2016 were treated in the Haematology Oncology Department of the Emergency Clinical Hospital for Children ‘Louis Ţurcanu’ Timişoara (current physician Dr.Carmen Petrescu). The cases were carefully investigated: clinical manifestations, neuroimaging aspects, congenital and acquired risk factors, treatment, complications, and outcome.

Results

The initial manifestations of CSVT in infants and small children (5/7), all with severe iron deficiency anaemia, preceding respiratory or digestive infections and severe dehydration, were nonspecific (vomiting, lack of appetite, lethargy), followed by seizures and coma (3/7); the older children (2/7) with chronic adeno-tonsillitis, had ocular disturbances, and respectively vomiting, headache and vertigo as onset symptoms. CSVT was diagnosed after cerebral CT scan/MRI, one to 14 days after the onset; the extension of thrombosis and parenchymal complications (venous/haemorrhagic infarctions) were correlated with the clinical manifestations and complications and presented for each case. Genetic predisposition for thrombosis was found in all cases: positive family history (4/7), and positive genetic profile (7/7). The anticoagulant treatment with unfractionated heparin was unsatisfactory (administration, monitoring, maintaining APTT in the therapeutic range, haemorrhagic complications), while treatment with low molecular weight heparins (enoxaparin, dalteparin) was efficient and safe. Two small children had long-term complications (e.g., hydrocephalus, cerebral atrophy; symptomatic epilepsy, hemiparesis).

Conclusions

Although CSVT are rare in children, their potentially fatal/severe outcome, especially in small children, justifies increased paediatricians attention; an early diagnosis based on a high index of suspicion (especially tacking into account the nonspecific initial manifestations) and adequate neuroimaging techniques, correction of age-specific acquired risk factors (e.g., severe iron deficiency anaemia, dehydration), and efficient and safe anticoagulant treatment could reduce immediate complications and long-term sequelae.

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