Diagnosis and management of cerebral venous sinus thrombosis in children: a single-center retrospective analysis
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ORIGINAL ARTICLE
Diagnosis and management of cerebral venous sinus thrombosis in children: a single-center retrospective analysis Ilaria Lazzareschi 1 & Antonietta Curatola 1 & Antonio Gatto 2 & Filomena Maellaro 3 & Paolo Frassanito 4 & Maria Basso 5 & Raimondo De Cristofaro 5,6 & Piero Valentini 1 Received: 10 September 2020 / Accepted: 29 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Cerebral venous thrombosis (CVT) is a rare disease in children, characterized by partial or total occlusion of blood flow in the cerebral venous system. The aim of this study is to describe clinical presentation, neuroimaging features, therapeutic management, and outcome of children with CVT. Methods We retrospectively analyzed the data, including clinical manifestations, laboratory data, neurological findings, and treatment of children with radiologically confirmed CVT, admitted between January 2010 and March 2020 to our hospital. Cases of CVT complicating brain surgery were excluded. Results We enrolled 24 children with CVT. Infection was the main etiology (58.3%), followed by trauma in 16.7% of cases. In the remaining 25% of cases, the cause was identified only in one patient presenting a thrombophilic factor. The most frequent site of thrombosis was the superficial venous system (86.8%), with multiple localizations disclosed in 79% of patients. All children received anticoagulant therapy with low molecular weight heparin (LMWH). One patient died for systemic complications of an underlying disease. No patient developed hemorrhagic events during the therapy, lasting from 35 to 360 days (mean 86 days). In all but one surviving patients (22 out of 24), recanalization of the sinus was observed at AngioMRI performed during follow-up. No neurological complications of CVT were recorded (mean follow-up: 1.5 year). Conclusions CVT may present with subtle and unspecific clinical manifestations in children. High level of suspicion should be kept in trauma and sinusitis. Anticoagulation treatment is safe and effective and should be promptly started to improve outcome. Keywords Cerebral venous thrombosis . Anticoagulant therapy . Children . Personalized medicine
* Antonietta Curatola [email protected] 1
Dipartimento di Pediatria, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
2
Dipartimento di Pediatria, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
3
Istituto di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy
4
Dipartimento di Neurochirurgia Infantile, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
5
Servizio di Malattie Emorragiche e Trombotiche, Area di Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
6
Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy
Abbreviations ATIII Antithrombin III CTV Computed tomography venography CVT Cerebral venous thrombosis IN
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