From the Stroke Units and Departments of Neurology of Hôpital Bicêtre (J.D., N.L., C.D.), Le Kremlin Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), and Paris Saclay University; Hôpital Lariboisière (I.C.), AP-HP, Paris; Pediatric Neurology and Stroke Unit (C.B.), AP-HP, Hôpital Bicêtre; University Région Bourgogne (Y.B.), Hôpital de Dijon; Hôpital Bichat (C.G.), AP-HP, Paris; Hôpital André Mignot (F.P.), Versailles; Hôpital Armand Trousseau (D.R.), AP-HP; Hôpital Fondation Rothschild (M.O.); Hôpital Robert Debré (D.G.), AP-HP; French National Health Insurance (CNAM) (P.T.); and Pediatric Neurology Unit and French Center for Pediatric Stroke (M.K.), AP-HP, Hôpital Necker-Enfants malades, Paris, France.
Neurology. 2021 Nov 9;97(19):e1920-e1932. doi: 10.1212/WNL.0000000000012828. Epub 2021 Sep 20.
We aimed to analyze the epidemiologic, clinical, and paraclinical features of adolescents with cerebral venous thrombosis (CVT) and its therapeutic management and outcome.
This multicenter retrospective cohort included patients 10 to 18 years of age hospitalized for a first episode of CVT in 2 French regions between 1999 and 2019. The number of cases was compared to the number recorded by the French health insurance system. The CVT registry of the Lariboisière hospital allowed comparisons with adults.
One hundred two patients were included (52.9% female; median age 15.1 years). Estimated incidence was 0.37 to 0.38 per 100,000 adolescents per year; 45.5% of patients presented with focal deficits or seizures or in a coma. Male patients were younger than female patients (14.2 vs 15.6 years; < 0.01) and more often admitted to intensive care (52.1% vs 24.1%; = 0.0,035). The lateral sinus was the most common CVT location (72.3%), and 29.4% of adolescents had associated venous infarction or hematoma. Most patients (94.1%) received anticoagulation. Treatment also included an endovascular procedure (2.9%), decompressive craniectomy (4.9%), and CSF shunt (6.9%). The most frequently identified CVT-associated condition was local infection in male (18.6%) and systemic disease in female (14.8%; < 0.001) patients. The proportion of CVTs in adolescents without an identified associated condition or risk factor was low (1.9% vs 11.4% in adults; < 0.002). Adverse outcome at 1 year was more frequent than in adults (33.3% vs 11.8%; = 0.0,001).
CVT in adolescents is rare and complex with specific epidemiology, including differences in clinical presentation and associated conditions between sexes, and more severe outcomes than in adults. Careful specialized management and follow-up are therefore recommended.
我们旨在分析青少年脑静脉血栓形成（CVT）的流行病学、临床和临床前特征，以及其治疗管理和结局。
这项多中心回顾性队列研究纳入了 1999 年至 2019 年期间在法国两个地区因首次 CVT 住院的 10 至 18 岁患者。将病例数与法国医疗保险系统记录的病例数进行比较。Lariboisière 医院的 CVT 登记处允许与成人进行比较。
共纳入 102 例患者（52.9%为女性；中位年龄为 15.1 岁）。估计发病率为每年每 10 万名青少年 0.37 至 0.38 例；45.5%的患者出现局灶性缺损或癫痫发作或昏迷。男性患者比女性患者年轻（14.2 岁比 15.6 岁； ＜0.01），更常入住重症监护病房（52.1%比 24.1%； = 0.035）。横窦是最常见的 CVT 部位（72.3%），29.4%的青少年存在静脉梗死或血肿。大多数患者（94.1%）接受抗凝治疗。治疗还包括血管内操作（2.9%）、减压性颅骨切除术（4.9%）和脑脊液分流术（6.9%）。最常发现的 CVT 相关疾病是男性的局部感染（18.6%）和女性的系统性疾病（14.8%； ＜0.001）。青少年中无明确相关疾病或危险因素的 CVT 比例较低（1.9%比成年人的 11.4%； ＜0.002）。1 年时的不良结局比成年人更常见（33.3%比 11.8%； = 0.001）。
青少年 CVT 罕见且复杂，具有特定的流行病学特征，包括男女之间临床表现和相关疾病的差异，以及比成年人更严重的结局。因此，建议进行仔细的专业管理和随访。
