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Berfelo FJ, Kersbergen KJ, van Ommen CH, Govaert P, van Straaten HL, Poll-The BT, van Wezel-Meijler G, Vermeulen RJ, Groenendaal F, de Vries LS, de Haan TR. Neonatal Cerebral Sinovenous Thrombosis From Symptom to Outcome. Stroke 2010; 41:1382-8. [DOI: 10.1161/strokeaha.110.583542] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background and Purpose—
Cerebral sinovenous thrombosis is a rare disease with severe neurological sequelae. The aim of this retrospective multicenter study was to investigate the clinical course, possible risk factors, and outcome of a cohort of neonatal patients with sinovenous thrombosis and, second, to estimate the incidence in The Netherlands.
Methods—
From January 1999 to March 2009, a review of all neonatal patients with sinovenous thrombosis from 6 tertiary neonatal intensive care units was performed. Population characteristics, clinical presentation, (prothrombotic) risk factors, neuroimaging, interventions, and neurodevelopment were evaluated. An estimated incidence was calculated based on the Netherlands Perinatal Registry.
Results—
Fifty-two neonates were included (39 boys) with a median gestational age of 39 weeks (range, 30 to 42 weeks; 5 preterm). An assisted or complicated delivery occurred in 32 of 52. Presenting symptoms developed at a median postnatal age of 1.5 days (range, 0 to 28 days) and consisted mainly of seizures (29 of 52). All sinovenous thrombosis cases were confirmed with MRI/MR venography. Multisinus thrombosis was most common followed by superior sagittal sinus thrombosis. FII G20210A mutation was present in 2 of 18 tested neonates (11%). Anticoagulation therapy (in 22 of 52) did not result in hemorrhagic complications. At follow-up (median age, 19 months; range, 3 to 72 months), moderate to severe neurological sequelae were present in 38%. The mortality was 10 of 52 (19%). A variable, although high yearly incidence of 1.4 to 12 per 100 000 term newborns was found.
Conclusions—
Neonatal sinovenous thrombosis is a multifactorial disease. The estimated incidence in The Netherlands seems higher than reported elsewhere.
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Affiliation(s)
- Florieke J. Berfelo
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - Karina J. Kersbergen
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - C. H.(Heleen) van Ommen
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - Paul Govaert
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - H. L.M.(Irma) van Straaten
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - Bwee-Tien Poll-The
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - Gerda van Wezel-Meijler
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - R. Jeroen Vermeulen
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - Floris Groenendaal
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - Linda S. de Vries
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
| | - Timo R. de Haan
- From the Department of Neurology (F.J.B.), Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (K.J.K., F.G., L.S.d.V.), Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands; the Department of Pediatric Haematology (C.H.v.O.), Emma Children’s Hospital, Academic Medical Center, Amsterdam, The Netherlands; the Department of Neonatology (P.G.), Sophia Children’s Hospital, Erasmus Academic Medical Center, Rotterdam, The Netherlands; the
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