A Comprehensive Examination of Clinical Characteristics and Determinants of Long-Term Outcomes in Pediatric Cerebral Sinus Venous Thrombosis

Objective To analyze the clinical and neuroimaging features, risk factors, treatment choices, and long-term clinical outcomes in children with cerebral sinus venous thrombosis (CSVT). Methods This is a retrospective cohort study of children diagnosed with CSVT between 2002 and 2018 at Texas Children’s Hospital. Results A total of 183 children (male:62.3%) with CSVT were included. The average presenting age was 7.7 years (SD:5.6). The mean follow-up duration of 33.7 months (SD: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 exam findings included motor deficit (21.3%) and altered mental status (AMS, 20.2%). Neuroimaging features included hemorrhagic infarction (19.6%), ischemic infarction (8.2%), intracranial hemorrhage without infarction (5.5%). Most common site of thrombosis was 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, 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. Conclusions 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.