Introduction: Cortical vein thrombosis (CVT) is an uncommon site of involvement in cerebral sinovenous thrombosis (CSVT). Few reports have described pediatric CVT, and none have described its unique features. The aim of our study was to evaluate the clinical and radiographic features of a cohort of children with CSVT, comparing those with CVT to those without CVT.
Hypothesis: Children with CVT are more likely to experience acute restricted diffusion and chronic venous infarction, as compared to those without CVT.
Methods: Children diagnosed with CSVT from 2006 to 2014 were enrolled in a prospective cohort study at a single tertiary care center. Inclusion criteria comprised confirmation of CSVT on acute imaging with MRI/MRV or CTV, and availability of follow-up imaging at subacute and chronic time periods. Patients were separated into two groups: those with CVT (CVT group) and those without (non-CVT group). Patient demographics, clinical presentation, and imaging findings were collected and analyzed using a two-tailed Fisher's exact test. Scans were reviewed for clot location and parenchymal abnormalities.
Results: Fifty patients met inclusion criteria, including 12 with CVT. In both groups, children frequently presented with headache and focal neurological deficits. However, the CVT group was more likely to present with seizure (P = 0.0271), altered mental status (P = 0.0271), and a family history of clotting disorder (P = 0.0477). Acute imaging of the CVT group more commonly demonstrated concurrent superior sagittal sinus thrombosis (P = 0.0024) and restricted diffusion (P < 0.0001); and follow-up imaging in the CVT group more commonly showed venous infarction (P = 0.0007).
Conclusions: The presence of CVT in our pediatric CSVT cohort was significantly associated with seizures at presentation, venous-territory restricted diffusion on acute imaging, and venous infarction at follow up. While further work is needed to confirm our results, involvement of cortical veins in CSVT appears to be associated with an increased risk of infarction in children.