Abstract Details

Title Clinical Presentation, Neuroimaging Characteristics and Long-term Outcome in Pediatric Cerebral Venous Sinus Thrombosis: A Retrospective Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-052

Objective

To delineate clinical/neuroimaging findings, risk factors, presenting clinical features, choice of treatment and long-term neurological outcomes in children with cerebral sinus venous thrombosis (CSVT).

Background

Pediatric CSVT is a rare condition with a prevalence of ~1 in 200,000 children. There is significant lack of literature on clinical and neuroimaging features, related complications and long-term outcome in children with CSVT.

Design/Methods We performed a retrospective chart-review study on children diagnosed with CSVT in a single tertiary referral center between 1996 and 2017.

Results 148 patients were diagnosed with CSVT using computed tomography (CT)/magnetic resonance imaging (MRI) and/or brain venograms (CTV and MRV). Average follow-up time was 3.6 years (range 1 week to 17 years). Average age was 7.2 years (range 1 month to 19 year of age). Of 148 patients, 92 (62%) were males and 56 (38%) were females. Common underlying risk factors included head and neck infections (37%), prothrombotic disorders (11%), hematologic malignancies (10%), and trauma (8%). Headache (35%), fever (25%), and seizure (21%) were amongst the most common presenting clinical features. On initial neurological exam; 32% were normal, 24% had motor deficit, 20% had cranial nerve deficit, 16% had altered mental status and 15% had papilledema. Neuroimaging findings included both infarction and hemorrhage (19%), isolated ischemic infarction (13%), other intracranial hemorrhages (5%), and no parenchymal lesions (68%). More than one location of thrombosis was reported in 75% and common sites included left transverse sinus (36%), right transverse sinus (36%) and superior sagittal sinus (35%). Treatment included low molecular weight heparin (62%), unfractionated heparin (17%) and warfarin (6%). Follow up neurological status was normal in 61%, abnormal in 23%, and death was reported in 7% of all children.

Conclusions CSVT may lead to detrimental long term outcome in a significant portion of pediatric patients. Thus, appropriate management and early intervention are necessary.

Authors/Disclosures
Cemal Karakas, MD (Norton Children's Hospital, University of Louisville) PRESENTER	Dr. Karakas has nothing to disclose.
Danielle Takacs, MD (Baylor College of Medicine/Texas Children's Hospital)	Dr. Takacs has received publishing royalties from a publication relating to health care.
Ethan Edmondson, MD	Dr. Edmondson has nothing to disclose.
Kristen Fisher, DO (Baylor College of Medicine)	Dr. Fisher has nothing to disclose.
Nikita Shukla, MD (BCM)	The institution of Dr. Shukla has received research support from Roche.
Gary D. Clark, MD (Baylor College of Medicine)	The institution of Dr. Clark has received research support from Greewich pharmaceuticals. The institution of Dr. Clark has received research support from Novartis.
Davut Pehlivan, MD	Dr. Pehlivan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ionis Pharmaceuticals.

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