Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Neurology and Neurophysiology, Baylor College of Medicine, Houston, Texas; Division of Pediatric Neurology, Department of Neurology, Norton Children's Medical Group, University of Louisville, Louisville, Kentucky.
Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Boys Town National Research Hospital, Boys Town, Nebraska.
Pediatr Neurol. 2024 Jun;155:76-83. doi: 10.1016/j.pediatrneurol.2024.03.022. Epub 2024 Mar 26.
To analyze the clinical and neuroimaging features, risk factors, treatment choices, and long-term clinical outcomes in children with cerebral sinus venous thrombosis (CSVT).
This is a retrospective cohort study of children diagnosed with CSVT between 2002 and 2018 at Texas Children's Hospital.
A total of 183 children (male: 62.3%) with CSVT were included. The average presenting age was 7.7 years (S.D.: 5.6). The mean follow-up duration was 33.7 months (S.D.: 38.6). The most common presenting clinical feature was headache (36.6%). Head and neck infections other than meningitis (36.6%) were the most common risk factors. Prevalent neurological examination findings included motor deficit (21.3%) and altered mental status (AMS, 20.2%). Neuroimaging features included hemorrhagic infarction (19.6%), ischemic infarction (8.2%), and intracranial hemorrhage without infarction (5.5%). The most common site of thrombosis was the superior sagittal sinus (37.2%), with 78.2% of patients demonstrating involvement of multiple sinuses. Treatment of choice was low-molecular-weight heparin in 69.4% of patients. Factors associated with worse clinical outcomes included head and neck infections, malignancy (other than hematologic), cardiac disease, and recent surgery; seizure and dehydration on initial presentation; motor abnormalities and AMS on initial examination; ischemic infarct only; and involvement of vein of Trolard on neuroimaging. Thrombus condition on repeat imaging, receiving any anticoagulant/antithrombotic treatment, treatment duration, or follow-up duration was not associated with severity of long-term outcome.
CSVT may lead to unfavorable long-term outcomes in a remarkable portion of pediatric patients. Thus, a high index of suspicion and early and appropriate management of pediatric CSVT is imperative.
分析儿童脑静脉窦血栓形成（CSVT）的临床和神经影像学特征、危险因素、治疗选择以及长期临床结局。
这是一项回顾性队列研究，纳入了 2002 年至 2018 年期间在德克萨斯儿童医院诊断为 CSVT 的儿童。
共纳入 183 例 CSVT 患儿（男：62.3%）。平均发病年龄为 7.7 岁（标准差：5.6）。平均随访时间为 33.7 个月（标准差：38.6）。最常见的首发临床特征是头痛（36.6%）。除脑膜炎外的头颈部感染（36.6%）是最常见的危险因素。常见的神经检查发现包括运动障碍（21.3%）和意识状态改变（20.2%）。神经影像学特征包括出血性梗死（19.6%）、缺血性梗死（8.2%）和无梗死性颅内出血（5.5%）。最常见的血栓形成部位是上矢状窦（37.2%），78.2%的患者存在多个窦血栓形成。69.4%的患者选择低分子肝素治疗。与较差临床结局相关的因素包括头颈部感染、恶性肿瘤（非血液系统）、心脏病和近期手术；初始表现时出现癫痫发作和脱水；初始检查时存在运动异常和意识状态改变；仅存在缺血性梗死；以及神经影像学上存在 Trolard 静脉受累。重复影像学检查时的血栓状况、接受任何抗凝/抗血栓治疗、治疗持续时间或随访持续时间与长期结局的严重程度无关。
CSVT 可能导致相当一部分儿科患者出现不良的长期结局。因此，对儿科 CSVT 保持高度怀疑并进行早期和适当的管理至关重要。
