Moharir Mahendranath D, Shroff Manohar, Pontigon Ann-Marie, Askalan Rand, Yau Ivanna, Macgregor Daune, Deveber Gabrielle A
Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Child Neurol. 2011 Sep;26(9):1137-44. doi: 10.1177/0883073811408094. Epub 2011 May 31.
Neonatal cerebral sinovenous thrombosis is a frequent contributor to neonatal mortality and morbidity. Treatment is controversial, and reported clinical outcomes vary widely. Newborns with radiologically confirmed neonatal cerebral sinovenous thrombosis from 1992 to 2009 were prospectively followed in our Children's Stroke Clinic for standardized outcomes, including the Pediatric Stroke Outcome Measure. Outcomes were available in 90 of 104 (87%) neonates. Early outcomes included cerebral sinovenous thrombosis-associated death (5) and thrombus propagation (15 [6 associated with new venous infarcts]). Lack of anticoagulation predicted propagation (RR = 13; P = .0007). Complete thrombus recanalization occurred in 90% by 3 months. Late outcomes (median, 2.5 years) were epilepsy (15) and neurological disability (50), which included moderate-severe language (43), sensorimotor (38), and cognitive/behavioral (24) deficits. Overall, 61% had poor outcome (death/any deficit). Concurrent neurological comorbidity at diagnosis (odds ratio = 2.8; P = .029) predicted poor outcome. Clinical trials are urgently needed to establish more effective treatment strategies.
新生儿脑静脉窦血栓形成是导致新生儿死亡和发病的常见原因。治疗存在争议，报告的临床结果差异很大。1992年至2009年期间，在我们的儿童卒中诊所对经放射学确诊的新生儿脑静脉窦血栓形成的新生儿进行了前瞻性随访，以获取标准化结果，包括儿童卒中结局测量。104例新生儿中有90例（87%）获得了结局数据。早期结局包括脑静脉窦血栓形成相关死亡（5例）和血栓扩展（15例[6例与新的静脉梗死相关]）。未进行抗凝治疗预示着血栓扩展（相对风险=13；P=0.0007）。到3个月时，90%的血栓完全再通。晚期结局（中位时间为2.5年）为癫痫（15例）和神经功能障碍（50例），其中包括中度至重度语言障碍（43例）、感觉运动障碍（38例）和认知/行为障碍（24例）。总体而言，61%的患儿预后不良（死亡/任何缺陷）。诊断时并发神经合并症（比值比=2.8；P=0.029）预示预后不良。迫切需要进行临床试验以建立更有效的治疗策略。
