Abstract Details

Title Use of intra-dural thrombolysis in a case of extensive pediatric Cerebral Sinus Venous Thrombosis (CSVT) and Venous infarction

Topic Child Neurology and Developmental Neurology

Presentation(s) P14 - Poster Session 14 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-002

Objective We report a case of extensive CSVT and venous infarction requiring mechanical thrombectomy and intradural thrombolysis.

Background CSVT is rare in the pediatric population, with prevalence of 0.67 cases per 100,000 children per year. Clinical presentations are usually non-specific and can be missed on non-contrast CT. Management of CSVT is usually with systemic anticoagulation as well as seizure management and neurosurgical intervention in selected cases. Mechanical thrombectomy is a safe option in challenging cases, with neurologic deterioration or those refractory to medical treatment.

Design/Methods Review of medical records, laboratory tests and imaging, was performed.

Results A 3-year-old male with history of speech delay and no family history of hypercoagulable disorders presented with acute unresponsiveness and rigidity. On presentation, he was unresponsive with postural rigidity and rigidity in bilateral lower extremities. He was hypotensive, received fluid resuscitationand was emergently intubated. There was concern for status epilepticus and he was administered antiepileptic therapy.Patient had multiple lab abnormalities including severe anemia, leukocytosis, and elevated lactic acid. Head CT revealed a thalamic hypodensity concerning for infarction. Brain MRI and MRV showed dural sinus and central venous thrombosis affecting the left transverse, sigmoid sinus, straight sinus and vein of Galenwhich extended extracranially to the deep cervical venous system. Patient was was started on Heparin. He also underwent 2 mechanical thrombectomies with successful partial recanalization. Patient remained minimally responsive off sedation with R sided hypertonia and bilateral lower extremity rigidity. Patient subsequently was administered intradural thrombolysis with alteplase. After 48 hours of intradural alteplase, patient’s mental status improved. At time of discharge, speech was improved, left upper extremity movement was purposeful and patient was able to ambulate for 75 feet.

Conclusions Use of intradural thrombolysis is an effective treatment in cases of extensive CSVT with no clinical improvement on medical therapy.

Authors/Disclosures
Aya A. Ouf, MBBS PRESENTER	Dr. Ouf has nothing to disclose.
	No disclosure on file
Gull Sial, MBBS	Dr. Sial has nothing to disclose.
Kathleen Sellick, DO	Dr. Sellick has nothing to disclose.
	No disclosure on file
	No disclosure on file
Leon A. Weinstock, MD (University Neurology, INC)	Dr. Weinstock has nothing to disclose.

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