Dados do Trabalho

Título

PEDIATRIC CEREBRAL SINOVENOUS THROMBOSIS: A CASE SERIES

Introdução

Cerebral sinovenous thrombosis (CSVT) is a rare event in the pediatric population, with an estimated incidence of 0.67 cases per 100,000 children annually. Though infrequent, its occurrence results both in acute life-threatening events, such as cerebral ischaemia, hemorrhage and edema, and permanent neurological impairment, notably motor and cognitive dysfunction and epilepsy.

Objetivo

To perform a clinical and epidemiological profiling of children with CSVT followed at the Neurovascular Clinic of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

Método

Overview of medical records was performed, from January 2018 to July 2024, aiming at determining the number of patients with a CSVT confirmed diagnosis, as well as gathering information of any pre-existing susceptibility, their symptoms, treatment and outcome.

Resultados

Results showed 20 patients with a CSVT established diagnosis, with a male-to-female ratio of 1:1. The most frequent causative nosology was a concurrent infectious insult (35%), followed by coagulopathies and head trauma, each with 20%. With regards to clinical initial presentation, headache was present in over half of the cases (55%), and seizures were present in 20%. The events were also discriminated by their topography, with superior sagittal sinus thrombosis being observed in 60% of cases. Subsequently, sigmoid and transverse sinuses comprised a total of 40% each, considering the frequent overlapping of multiple thrombosis sites. Anticoagulation with low-molecular-weight heparin (LMWH) was used in 70% of cases. Lastly, in their outcomes we found cerebral hemorrhage (35%), intracranial hypertension (IH) (30%) and cerebral sinovenous stenosis (5%).

Conclusão

Our data dialogues with previous case series and cohort studies in terms of conducive etiologies peculiar to the pediatric population, such as head and neck infections and acute systemic illnesses. Additionally, in our study, the first symptoms observed by caregivers were headache and seizures, whereas in contrast, international literature shows a higher prevalence of IH. As for sites of the CSVT, the limited number of cases and the various sinuses and veins susceptible to simultaneous thrombosis hampers the possibility of presuming favorite sites of involvement. Concerning treatment, anticoagulation with LMWH is standard care. Ultimately, the severe and abiding sequelae faced by these individuals should mobilize awareness to hinder permanent neurological deficits.

Referências

deVerber G et al. Cerebral sinovenous thrombosis in children. N Engl J Med. 2001;345(6):417-23. Ichord R. Cerebral Sinovenous Thrombosis. Front Pediatr. 2017;5:163. Lazzareschi I et al. Diagnosis and management of cerebral venous sinus thrombosis in children: a single-center retrospective analysis. Childs Nerv Syst. 2021;37(1):153-160. Saposnik G et al. Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association. Stroke. 2024;55(3):e77-e90.

Palavras Chave

Cerebral sinovenous thrombosis; Cerebrovascular disorders; Children