REVIEW – December 2012

Paediatric cerebral sinovenous thrombosis in Estonia

Authors: Rael Laugesaar, Sander Pajusalu, Liis Toome, Anneli Kolk, Tiiu Tomberg, Pilvi Ilves, Imbi Eelmäe, Inga Talvik, Tiina Talvik

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Cerebral sinovenous thrombosis is increasingly recognised in children due to improved brain imaging techniques and the relevant knowledge among physicians. The aim of the study was to review the clinical signs, risk factors, diagnostics and treatment of paediatric sinovenous thrombosis and to analyse the cases of paediatric sinovenous thrombosis diagnosed in Estonia.

Cerebral sinovenous thrombosis occurs both in newborns and older children (1 month to 18 years). According to epidemiological studies, the incidence of sinovenous thrombosis is 0.25–0.67/100 000 per year. The symptoms of cerebral sinovenous thrombosis are often nonspecific: most children present with diff use neurological symptoms, half of them have neurological defi cits. Respiratory and feeding problems, seizures and decreased muscular tone are common in the neonatal period. In most cases, the etiological factor is detectable: head or neck infections, dehydratation, acquired or inherited thrombophilia are the most common in childhood; perinatal factors are important in the neonatal period. The gold standard for the diagnosis of sinovenous thrombosis is magnetic resonance imaging with magnetic resonance venography or computed tomography (CT) with CT-venography. Both supportive treatment and early anticoagulation are important in the care of children with sinovenous thrombosis.

During the years 2005–2011, sinovenous thrombosis was diagnosed in 5 newborns and in 5 older children (average age 6.8 years).  The symptoms were mainly diff use. In neonates, the main risk factors were complicated delivery and inherited thrombophilia. In older children, dehydration, mastoiditis, nephrotic syndrome (acquired thrombophilia), and inherited thrombophilia predisposed to sinovenous thrombosis. In eight cases, the diagnosis of sinovenous thrombosis was established within 4 days, in two cases the diagnosis delayed signifi cantly. Six out of 10 children received early anticoagulant therapy.

In conclusion, as the symptoms of paediatric sinovenous thrombosis are nonspecific, sinovenous thrombosis should be considered in children with acute or subacute neurological illness with an unknown aetiology.