Pediatric Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.
Imunohemotherapy Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal.
Neurologia (Engl Ed). 2024 Oct;39(8):658-665. doi: 10.1016/j.nrleng.2024.09.002.
Cerebral venous thrombosis (CVT) is an uncommon and clinically heterogeneous cerebrovascular particularly in children, only a few published case series focused in the pediatric population.
Retrospective single-center observational and analytical study of consecutive pediatric patients admitted in a level II Portuguese hospital with a confirmed diagnosis of CVT, from 2003 to 2021. Clinical presentation, neuroimaging findings, prothrombotic factors, treatment strategies, outcome and recanalization were documented.
Twelve children were included (58% female). Mean age was 7.3 years. The most frequent symptoms were vomiting, headache and behavioral alterations. Infection was the triggering factor in 50% of the cases. The diagnosis of CVT was made based on imaging evidence of thrombosis through magnetic imaging resonance (MRI) with venography and/or computed tomography (CT) with venography. In 67% of cases there were multiples sinuses involved; the transverse sinus was the most affected, followed by the sigmoid sinus. In 83% of cases anticoagulant therapy was initiated with low molecular weight heparin (LMWH) and associated prothrombotic factors were investigated, with no major prothrombotic factors identified. No deaths occurred, but 30% had long-term neurological sequelae. One patient recurred 18 years later.
The results of this study are consistent with data from other published studies. MRI is the preferred imaging method for diagnosis in children by avoiding ionizing radiation and allowing identification of subjacent causes. Anticoagulation with LMWH is recommended and important to reduce mortality and sequelae. Infectious diseases are the most common trigger for CVT and can also be the cause for high morbidity and poor outcomes.
脑静脉血栓形成（CVT）是一种少见且临床表现多样的脑血管疾病，尤其是在儿童中，仅有少数发表的病例系列研究集中在儿科人群。
这是一项回顾性单中心观察性和分析性研究，纳入了 2003 年至 2021 年期间在葡萄牙一家二级医院确诊为 CVT 的连续儿科患者。记录了临床表现、神经影像学发现、血栓形成倾向因素、治疗策略、结局和再通情况。
共纳入 12 名儿童（58%为女性），平均年龄为 7.3 岁。最常见的症状是呕吐、头痛和行为改变。50%的病例为感染触发。CVT 的诊断基于血栓形成的影像学证据，通过磁共振成像（MRI）联合静脉造影和/或计算机断层扫描（CT）联合静脉造影。67%的病例有多个窦受累，横窦最常受累，其次是乙状窦。83%的病例开始抗凝治疗，使用低分子肝素（LMWH），并对潜在的血栓形成倾向因素进行了调查，未发现明显的血栓形成倾向因素。无死亡病例，但 30%存在长期神经后遗症。1 例患者 18 年后复发。
本研究结果与其他已发表研究的数据一致。MRI 是儿童诊断的首选影像学方法，可避免电离辐射，并能识别潜在的病因。推荐使用 LMWH 抗凝治疗，这对于降低死亡率和后遗症很重要。感染性疾病是 CVT 最常见的触发因素，也可能是高发病率和不良结局的原因。
