1
|
Johnson-Bishop L, Karakas C, Kralik SF, Cohen CT, Zobeck M, Park N, Rabin K, Pehlivan D, Bhar S. Cerebral Sinus Venous Thrombosis in Pediatric Acute Lymphoblastic Leukemia: Incidence, Clinical Characteristics, and Long-term Neurologic Outcomes. J Child Neurol 2024:8830738241282910. [PMID: 39324216 DOI: 10.1177/08830738241282910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
OBJECTIVE To describe the incidence, clinical characteristics, and long-term outcomes of cerebral sinus venous thrombosis in children with acute lymphoblastic leukemia. METHODS This was a retrospective cohort study comprising pediatric patients with newly diagnosed or first-relapse acute lymphoblastic leukemia who developed cerebral sinus venous thrombosis at Texas Children's Hospital from 2002 to 2019. RESULTS Nineteen cases (1.7%) with cerebral sinus venous thrombosis were identified in all pediatric patients with acute lymphoblastic leukemia (n = 1129). Increased risk of cerebral sinus venous thrombosis was observed with age >10 years (P = .006). Twelve cases (63%) occurred during the induction, 4 (21%) during maintenance, and 3 (16%) during the consolidation phases of leukemia therapy. Seizures (10/19) and headaches (9/19) were the most common presenting symptoms. After treatment with anticoagulation therapy, we observed full resolution of thrombosis in 10 (53%) and partial resolution in 8 patients (42%). Long-term neurologic outcomes at follow-up in the 14 patients who survived included normal neurologic examinations (n = 10), epilepsy (n = 3), and focal neurologic deficits (n = 2). The death occurred in 5 individuals. CONCLUSION Cerebral sinus venous thrombosis is a notable complication of pediatric acute lymphoblastic leukemia therapy. Older age (>10 years) was a risk factor for developing cerebral sinus venous thrombosis. Despite variable patient presentations and treatment durations, favorable clinical outcomes were observed in most patients after the treatment with anticoagulation for a minimum of 3 months.
Collapse
Affiliation(s)
- Lindsay Johnson-Bishop
- Department of Pediatrics, Division of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Cemal Karakas
- Division of Pediatric Neurology, Department of Neurology, Norton Children's Medical Group, University of Louisville, Louisville, KY, USA
| | - Stephen F Kralik
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Clay T Cohen
- Department of Pediatrics, Division of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mark Zobeck
- Department of Pediatrics, Division of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Nick Park
- Department of Pediatrics, Division of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Karen Rabin
- Department of Pediatrics, Division of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Davut Pehlivan
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Saleh Bhar
- Department of Pediatrics, Division of Hematology and Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
2
|
Yücel G, Arslan AK, Özgör B, Şahin MÇ, Öncül Y, Taşolar SD, Akyay A, Güngör S. Risk factors for acute symptomatic seizure in children with cerebral sinovenous thrombosis: Experience from a tertiary center. Clin Neurol Neurosurg 2024; 246:108571. [PMID: 39326278 DOI: 10.1016/j.clineuro.2024.108571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 09/20/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVE To investigate the risk factors for acute symptomatic seizure (ASS) in children with Cerebral Sinovenous Thrombosis (CSVT) and to evaluate the effect of ASS on outcome. METHODS Cross-sectional, single-center, hospital-based retrospective analysis of 42 children with neuroimaging-confirmed CSVT recorded between December 2009 and January 2023. ASS was defined as a seizure occurring within 7 days after CSVT. Predictors for ASS were analyzed by univariate and multivariate logistic regression. Functional outcomes were evaluated using the Pediatric Stroke Outcome Measure (PSOM). RESULTS The average age of the 42 patients included in the study sample was 105.36 ± 63.1 months. Almost one-third (28.6 %) of patients with CSVT developed ASS. In univariate analysis, factors associated with seizure risk were young age, low Glasgow Coma Scale at admission, long hospital stay, headache, change of consciousness, focal neurological findings, cerebral hemorrhage, motor deficit and high D-dimer level (p=0.018, p<0.001, p= 0.016, p= 0.001, p=0.014, p<0.001, p<0.001, p=0.019 and p=0.013, respectively). In multivariate analysis young age, focal neurological findings and D-dimer levels were potential predictors of ASS (p=0.004, p=0.003, p=0.036, respectively). Receiver operating characteristic (ROC) analysis for D-dimer diagnostic accuracy in patients with CSVT revealed D-dimer > 498 ng/mL (AUC=0.743). In both cohorts, PSOM scores at last follow-up were worse in those with acute seizures compared to those without (p<0.001). CONCLUSION Acute seizures occurred in approximately one-third of our cohort. Young age, focal neurological findings, and high D-dimer levels are potential predictors of ASS in children. Children with ASS had worse outcomes than those without.
Collapse
Affiliation(s)
- Gül Yücel
- Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Ahmet Kadir Arslan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Bilge Özgör
- Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Murat Çağlar Şahin
- Department of Pediatrics, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Yurday Öncül
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Sevgi Demiröz Taşolar
- Department of Pediatric Radiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Arzu Akyay
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| | - Serdal Güngör
- Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey.
| |
Collapse
|
3
|
Xie L, Xu Y, Zhou G, Chen F, Li C, Ma L, Wen F. Case Report: A successful outcome of nadroparin calcium therapy for cerebral venous sinus thrombosis in a child with acute lymphoblastic leukemia. Front Pediatr 2024; 12:1448445. [PMID: 39318612 PMCID: PMC11420003 DOI: 10.3389/fped.2024.1448445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 08/22/2024] [Indexed: 09/26/2024] Open
Abstract
Background The appearance of cerebral venous sinus thrombosis (CVST) in childhood acute lymphocytic leukemia (ALL) is a rare life-threatening disease that can cause significant morbidity, neurological sequelae, and potentially poor outcomes. Case presentation We present the case of a 13-year-old boy with ALL who developed CVST and intrinsic hemorrhage approximately 30 days after receiving chemotherapy with vincristine, dexamethasone, daunorubicin, and pegylated-asparaginase (PEG-Asp). He complained of a severe headache and then developed a generalized seizure at night. T1- and T2-weighted magnetic resonance imaging (MRI) and cerebral magnetic resonance venography sequences revealed superior sagittal sinus thrombosis and intrinsic hemorrhagic changes in the bilateral frontoparietal lobes. He received nadroparin calcium as the anticoagulant treatment and was switched to Erwinia asparaginase (Erwinia Asp) rather than PEG-Asp. Oxcarbazepine and clonazepam were started with good seizure control. Intrathecal treatment was delayed until 1 month later. Anticoagulation treatment was stopped for 24 h before and 6 h after lumbar puncture. Platelet transfusion was administered to ensure the platelet count remained at >50 × 109/L. Oral acetazolamide (500-1,000 mg, daily) was administered to relieve headache and reduce intracranial pressure. Three months later, brain MRI showed a complete resolution of or significant improvement in the filling defect. Nadroparin calcium was administered for 1 week after switching to Erwinia Asp to prevent clot recurrence. He completed the 6-month chemotherapy and is doing well with no neurological sequelae and no recurrence of bleeding or thrombosis. Conclusions Nadroparin calcium therapy appears to be safe and effective for pediatric CVST with ALL. The reintroduction of Erwinia Asp should be accompanied by anticoagulant therapy with nadroparin calcium.
Collapse
Affiliation(s)
- Lichun Xie
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Ye Xu
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guichi Zhou
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Fen Chen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Changgang Li
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Lian Ma
- Department of Pediatrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| | - Feiqiu Wen
- Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China
| |
Collapse
|
4
|
Song Y, Li S, Hao L, Han Y, Wu W, Fan Y, Gao X, Li X, Ren C, Chen Y. Risk factors of neonatal stroke from different origins: a systematic review and meta-analysis. Eur J Pediatr 2024; 183:3073-3083. [PMID: 38661815 DOI: 10.1007/s00431-024-05531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/26/2024]
Abstract
Given the persistent ambiguity regarding the etiology of neonatal stroke across diverse origins, our objective was to conduct a comprehensive evaluation of both qualitative and quantitative risk factors. An exhaustive search of eight databases was executed to amass all pertinent observational studies concerning risk factors for neonatal stroke from various origins. Subsequent to independent screening, data extraction, and bias assessment by two researchers, a meta-analysis was conducted utilizing RevMan and Stata software. Nineteen studies, encompassing a total of 30 factors, were incorporated into this analysis. Beyond established risk factors, our investigation unveiled gestational diabetes (OR, 5.51; P < 0.00001), a history of infertility (OR, 2.44; P < 0.05), placenta previa (OR, 3.92; P = 0.02), postdates (OR, 2.07; P = 0.01), preterm labor (OR, 2.32; P < 0.00001), premature rupture of membranes (OR, 3.02; P = 0.007), a prolonged second stage of labor (OR, 3.94; P < 0.00001), and chorioamnionitis (OR, 4.35; P < 0.00001) as potential risk factors for neonatal cerebral arterial ischemic stroke. Additionally, postdates (OR, 4.31; P = 0.003), preterm labor (OR, 1.60; P < 0.00001), an abnormal CTG tracing (OR, 9.32; P < 0.0001), cesarean section (OR, 4.29; P = 0.0004), male gender (OR, 1.73; P = 0.02), and vaginal delivery (OR, 1.39; P < 0.00001) were associated with an elevated risk for neonatal hemorrhagic stroke. CONCLUSIONS This study provides a succinct overview and comparative analysis of maternal, perinatal, and additional risk factors associated with neonatal cerebral artery ischemic stroke and neonatal hemorrhagic stroke, furnishing critical insights for healthcare practitioners involved in the diagnosis and prevention of neonatal stroke. This research also broadens the conceptual framework for future investigations. WHAT IS KNOWN • Research indicates that prenatal, perinatal, and neonatal risk factors can elevate the risk of neonatal arterial ischemic stroke (NAIS). However, the risk factors for neonatal cerebral arterial ischemic stroke remain contentious, and those for neonatal hemorrhagic stroke (NHS) and neonatal cerebral venous sinus thrombosis (CVST) are still not well-defined. WHAT IS NEW • This study is the inaugural comprehensive review and meta-analysis encompassing 19 studies that explore maternal, perinatal, and various risk factors linked to neonatal stroke of differing etiologies. Notably, our analysis elucidates eight risk factors associated with NAIS: gestational diabetes mellitus, a history of infertility, placenta previa, postdates, preterm birth, premature rupture of membranes, a prolonged second stage of labor, and chorioamnionitis. Furthermore, we identify six risk factors correlated with NHS: postdates, preterm birth, an abnormal CTG, the method of delivery, male gender, and vaginal delivery. Additionally, our systematic review delineates risk factors associated with CVST.
Collapse
Affiliation(s)
- Yankun Song
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Shangbin Li
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Ling Hao
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Yiwei Han
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Wenhui Wu
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Yuqing Fan
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiong Gao
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Xueying Li
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China
| | - Changjun Ren
- Department of Pediatrics, First Affifiliated Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, 050000, China.
| | - Yuan Chen
- Department of Pediatrics, the Second Hospital of Hebei medical university, Hebei Medical University, Shijiazhuang, 050000, China.
| |
Collapse
|
5
|
Sun JA, Estrela T, Gise R. Clinical Course and Visual Outcomes of Papilledema in Pediatric Cerebral Venous Sinus Thrombosis. Am J Ophthalmol 2024; 263:126-132. [PMID: 38395330 DOI: 10.1016/j.ajo.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Cerebral venous sinus thrombosis (CVST) is a rare but life-threatening event with significant neurologic and visual morbidity. In this study, we report on the natural history and visual outcomes of papilledema in children with CVST. DESIGN Retrospective case series. METHODS Patients with CVST evaluated by the Department of Ophthalmology between 2000 and 2023 were included. Records were reviewed for presence and course of papilledema, treatment, and final visual outcomes following papilledema resolution. RESULTS The study included 35 patients with a mean age of 9 ± 5 years and 40% were female. The most common risk factors for CVST were infection (69%), dehydration (26%), and hypercoagulability (23%). 31 patients (89%) had papilledema. Of these patients, 9 (29%) had progression of papilledema despite treatment, 17 patients (55%) did not have progression, and 5 patients (16%) lacked follow-up records. Initial Frisén grade among all cases was 2 ± 1, and cases with progression reached a grade of 4 ± 1 between 10 and 32 days following initial identification. Most patients (97%) were treated with anticoagulation and 100% required acetazolamide and/or lumbar puncture. Among 26 patients with follow-up, papilledema resolved in 107 ± 128 days. Fifty-four percent of patients had permanent ophthalmic sequelae. An initial Frisén grade ≥3 (odds ratio 7.54, 95% confidence interval 6.53-8.70, P< .001) was significantly associated with eventual optic atrophy. CONCLUSIONS Children with CVST are at high risk for ophthalmologic sequelae. Papilledema can progress despite appropriate therapy. Our results highlight the importance of ophthalmologic follow-up during treatment course to prevent irreversible vision loss.
Collapse
Affiliation(s)
- Jessica A Sun
- From the Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tais Estrela
- From the Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan Gise
- From the Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
6
|
Nguyen VN, Demetriou AN, Dallas J, Mack WJ. Cerebral Venous Sinus Thrombosis. Neurosurg Clin N Am 2024; 35:343-353. [PMID: 38782527 DOI: 10.1016/j.nec.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare type of stroke indicated by the formation of blood clots within the dural venous sinuses. These are large venous conduits that are situated between the 2 layers of the dura mater which are responsible for draining blood from the brain and returning it to the systemic circulation. Cortical venous thrombosis refers to the blockage of veins on the brain's cortical surface. Cerebral venous thrombosis encompasses both dural and cortical vein occlusions.
Collapse
Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Alexandra N Demetriou
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Jonathan Dallas
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - William J Mack
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA.
| |
Collapse
|
7
|
Pais-Cunha I, Almeida AI, Curval AR, Fonseca J, Melo C, Sampaio M, Sousa R. Cerebral Venous Thrombosis in Pediatric Age: Risk Factors and Prognosis. Neuropediatrics 2024; 55:183-190. [PMID: 38057147 DOI: 10.1055/a-2223-6395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is a rare but potentially fatal disease in pediatric age with an important morbimortality. In adults several factors have been associated with worse outcomes, however there are still few studies in children. This study aims to identify risk factors associated with clinical manifestations and long-term sequelae in pediatric CVT. METHODS Retrospective analysis of pediatric inpatients admitted to a tertiary-care hospital due to CVT between 2008 and 2020. RESULTS Fifty-four children were included, 56% male, median age of 6.5 years (9 months-17.3 years). Permanent risk factors were identified in 13 patients (malignancy, 8; hematologic condition, 5) and transient risk factors in 47, including head and neck infections (57%) and head trauma (15%). Multiple venous sinuses involvement was present in 65% and the deep venous system was affected in four patients. Seventeen percent had intracranial hemorrhage and 9% cerebral infarction. Sixty-four percent of patients with multiple venous sinuses involvement presented with severe clinical manifestations: impaired consciousness, intracranial hypertension, acute symptomatic seizures or focal deficits. Regarding long-term prognosis, six patients had major sequelae: epilepsy (n = 3), sensory motor deficits (n = 2), and cognitive impairment (n = 3). Permanent risk factors were associated with severe clinical manifestations (p = 0.043). Cerebral infarction and intracranial hemorrhage were associated with major sequelae (p = 0.006 and p = 0.03, respectively, adjusted for age and sex). CONCLUSION Permanent risk factors, involvement of multiple venous sinuses, intracranial hemorrhage, and cerebral infarction, were related to worse prognosis. Detection and early management of risk factors may limit CVT extension and reduce its morbimortality.
Collapse
Affiliation(s)
- Inês Pais-Cunha
- Serviço de Pediatria, Unidade Autónoma Gestão da Mulher e da Criança, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana I Almeida
- Serviço de Neurorradiologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana R Curval
- Serviço de Pediatria, Unidade Autónoma Gestão da Mulher e da Criança, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jacinta Fonseca
- Unidade de Neuropediatria, Unidade Autónoma Gestão da Mulher e da Criança, Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Cláudia Melo
- Unidade de Neuropediatria, Unidade Autónoma Gestão da Mulher e da Criança, Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Mafalda Sampaio
- Unidade de Neuropediatria, Unidade Autónoma Gestão da Mulher e da Criança, Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Raquel Sousa
- Unidade de Neuropediatria, Unidade Autónoma Gestão da Mulher e da Criança, Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| |
Collapse
|
8
|
Karakas C, Herman I, Kralik SF, Webber TA, Takacs DS, Bhar S, Pehlivan D. A Comprehensive Examination of Clinical Characteristics and Determinants of Long-Term Outcomes in Pediatric Cerebral Sinus Venous Thrombosis. Pediatr Neurol 2024; 155:76-83. [PMID: 38608552 DOI: 10.1016/j.pediatrneurol.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND 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 (S.D.: 5.6). The mean follow-up duration was 33.7 months (S.D.: 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 examination findings included motor deficit (21.3%) and altered mental status (AMS, 20.2%). Neuroimaging features included hemorrhagic infarction (19.6%), ischemic infarction (8.2%), and intracranial hemorrhage without infarction (5.5%). The most common site of thrombosis was the 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, and 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.
Collapse
Affiliation(s)
- Cemal Karakas
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Neurology and Neurophysiology, Baylor College of Medicine, Houston, Texas; Division of Pediatric Neurology, Department of Neurology, Norton Children's Medical Group, University of Louisville, Louisville, Kentucky
| | - Isabella Herman
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Boys Town National Research Hospital, Boys Town, Nebraska
| | - Stephen F Kralik
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Troy A Webber
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Danielle S Takacs
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Neurology and Neurophysiology, Baylor College of Medicine, Houston, Texas
| | - Saleh Bhar
- Division of Hematology and Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Davut Pehlivan
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
9
|
McGetrick ME, Riviello JJ. Neurological injury in pediatric heart disease: A review of developmental and acquired risk factors and management considerations. Semin Pediatr Neurol 2024; 49:101115. [PMID: 38677794 DOI: 10.1016/j.spen.2024.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 04/29/2024]
Abstract
Medical and surgical advancements have improved survival in children with acquired and congenital heart disease (CHD), but the burden of neurological morbidity is high. Brain disorders associated with CHD include white matter injury, stroke, seizure, and neurodevelopmental delays. While genetics and disease-specific factors play a substantial role in early brain injury, therapeutic management of the heart disease intensifies the risk. There is a growing interest in understanding how to reduce brain injury and improve neurodevelopmental outcomes in cardiac diseases. Pediatric neurologists serve a vital role in care teams managing these complex patients, providing interpretation of neuromonitoring and imaging, managing neurologic emergencies, assisting with neuro prognostication, and identifying future research aims.
Collapse
Affiliation(s)
- Molly E McGetrick
- Division of Cardiology and Critical Care, Department of Pediatrics, the University of Texas Southwestern, Children's Medical Center, Dallas, Texas, USA.
| | - James J Riviello
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
10
|
Johansen PM, Ciavarra B, McCormack R, Kole M, Spiegel G, Fletcher SA. Superior Sagittal Sinus Thrombectomy in Pediatric Head Injury. Pediatr Neurosurg 2024; 59:94-101. [PMID: 38461817 DOI: 10.1159/000538184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Injury and subsequent thrombosis of the cerebral venous sinuses may be caused by closed head injuries secondary to a variety of different mechanisms. Skull fractures can lacerate or otherwise disrupt adjacent dural sinuses. The sequelae of such injuries may include thrombosis and either partial or total occlusion of the sinus, ultimately resulting in significant venous congestion. Sagittal sinus injury is associated with a more serious outcome due to the obligatory flow into the sinus, especially posterior to the coronal suture. In such cases, venous infarction may be a severe and life-threatening complication of head injury. CASE PRESENTATION A 2-year-old female presented with a depressed skull fracture near the midline and a thrombus in the sagittal sinus. Anticoagulation, the standard treatment cerebral venous sinus thrombosis (CVST), was contraindicated due to intracranial hemorrhage, so immediate thrombectomy was performed with successful neurologic recovery at 9-month follow-up. To our knowledge, this case is the youngest patient documented to receive mechanical thrombectomy for superior sagittal sinus (SSS) thrombosis due to trauma. CONCLUSION Closed head injuries in pediatric patients may be associated with CVST, with resulting venous drainage compromise and profound neurologic sequelae. Unlike adult patients with spontaneous CVST in which anticoagulation are the standard of care, pediatric patients experiencing traumatic CVST may have contraindications to anticoagulants. If the patient has a contraindication to anticoagulation such as intracranial bleeding, endovascular mechanical thrombectomy may be an effective intervention when performed by an experienced neurointerventionalist.
Collapse
Affiliation(s)
| | - Bronson Ciavarra
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ryan McCormack
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Matthew Kole
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gary Spiegel
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Stephen Alan Fletcher
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
11
|
Proaño JS, Martinez PA, Sendi P, Totapally BR. Characteristics and Outcomes of Children with Cerebral Sinus Venous Thrombosis. Neurocrit Care 2023; 39:331-338. [PMID: 37438549 DOI: 10.1007/s12028-023-01765-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/19/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Cerebral sinus venous thrombosis (CSVT) is an uncommon condition in children with potentially serious outcomes. Large epidemiological studies in children with CSVT are few. The objective of this study is to evaluate the epidemiology and in-hospital outcomes of hospitalized children with CSVT in the United States. METHODS We performed a retrospective cross-sectional analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database for the combined years 2016 and 2019. The database was queried using the diagnoses for intracranial and intraspinal phlebitis and thrombophlebitis, nonpyogenic thrombosis of the intracranial venous system, and cerebral infarction due to cerebral venous thrombosis. Sample weighting was employed to produce national estimates. RESULTS Of 12,165,621 discharges, 3202 had CSVT (in-hospital prevalence 26.3 per 100,000 discharges). Male patients accounted for 57% of CSVT discharges. The median age was 8 years (interquartile range 1-16), with a U-shaped distribution with peaks in patients younger than 4 years and patients aged between 18 and 20 years. A total of 19.3% of children with CSVT had either hemorrhagic or ischemic stroke. Patients with stroke were more likely to require mechanical ventilation (odds ratio [OR] 2.7; 95% confidence interval [CI] 2.1-3.3; p < 0.001) and have higher mortality (OR 2.3; 95% CI 1.6-3.4; p < 0.001). Mechanical ventilation was necessary for 25.2% of patients with CSVT, of whom the majority were neonates and young children. The need for mechanical ventilation was associated with increased mortality (OR 16.6; 95% CI 9.9-27.9; p < 0.001). The overall mortality rate for CSVT was 4.1%, and 16.5% of patients with CSVT were discharged with home health care or to a skilled nursing facility. CONCLUSIONS CSVT, which has a U-shaped age distribution, is an uncommon condition in children. Stroke is common in children with CSVT, and it is associated with an increased need for mechanical ventilation and increased mortality. The need for mechanical ventilation is more common in infants, and it is associated with increased mortality across all age groups.
Collapse
Affiliation(s)
- Juan Sebastian Proaño
- Marshall University Joan C Edwards School of Medicine, 1600 Medical Center Drive, Huntington, WV, 25705, USA.
| | - Paul A Martinez
- Department of Pediatric Critical Care, Nicklaus Children's Hospital, Miami, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Prithvi Sendi
- Department of Pediatric Critical Care, Nicklaus Children's Hospital, Miami, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Balagangadhar R Totapally
- Department of Pediatric Critical Care, Nicklaus Children's Hospital, Miami, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| |
Collapse
|
12
|
Lenglart L, Monteil C, Spreafico E, Moulding T, Titomanlio L. Sudden onset headaches in paediatric emergency departments: diagnosis and management. Ital J Pediatr 2023; 49:122. [PMID: 37710275 PMCID: PMC10503087 DOI: 10.1186/s13052-023-01526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
Headache is one of the most common pain syndromes in the paediatric population. Headaches are classified as primary (migraine, tension-type headaches, trigeminal autonomic cephalalgia and other primary headaches) or secondary (e.g. post-traumatic). Non-febrile, non-traumatic headaches represent 1% of all paediatric emergency departments (PED) visits. Many patients present with an acute, moderate to severe pain, sometimes with a sudden onset. Sudden onset headache can be the main symptom of life-threatening neurological conditions as well as a sign of primary headaches such as thunderclap or stabbing headaches. This review aims to describe the presentation of sudden primary headaches in children, in order to help the physician to provide effective management in the emergency setting.
Collapse
Affiliation(s)
- Léa Lenglart
- Paediatric Emergency Department, APHP - Hopital Robert Debré, 48 Boulevard Serurier, Paris, 75019, France.
| | - Cécile Monteil
- Paediatric Emergency Department, APHP - Hopital Robert Debré, 48 Boulevard Serurier, Paris, 75019, France
| | - Eugenia Spreafico
- Paediatric Department, IRCCS Fondazione Policlinico S. Matteo, University of Pavia, Pavia, Italy
| | - Thomas Moulding
- Paediatric Department, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Luigi Titomanlio
- Paediatric Emergency Department, APHP - Hopital Robert Debré, 48 Boulevard Serurier, Paris, 75019, France
- Paediatric Migraine and Neurovascular Diseases Unit, APHP - Hopital Robert Debré, Paris, France
- Paris University, INSERM U1141, DHU Protect, Paris, France
| |
Collapse
|
13
|
Lu X, Yan C, Chen H, Wu X. Analysis of 6 pediatric nephrotic syndrome cases with complications of cerebral sinovenous thrombosis and literature review. Front Pediatr 2023; 11:1226557. [PMID: 37753194 PMCID: PMC10518416 DOI: 10.3389/fped.2023.1226557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
Background Cerebral venous sinus thrombosis (CVST) is a rare but serious complication of nephrotic syndrome (NS) in children. To investigate the clinical characteristics of CVST in children with NS in order to timely diagnose this complication and reduce poor outcome. Methods Collect and analyze clinical data and magnetic resonance venography (MRV) results of children with NS complicated with CVST. Results Data of 6 patients with NS complicated with CVST were collected. 4 of the patients were steroid-sensitive nephrotic syndrome (SSNS) and 2 were steroid-resistant nephrotic syndrome (SRNS). The occurrence of CVST was observed within a time frame ranging from 12 days to 3 years following the diagnosis of NS. One patient had two episodes of thrombosis in three years, while the other five patients had only one episode of thrombosis. All patients had proteinuria at the time of episode of thrombosis. All patients presented with headache, and three of them had strabismus, seizures, and transient blindness, respectively. Neurological examination was negative. All patients were diagnosed with CVST by MRV within 3-16 days of the onset of headache. Two patients had TRPC6 gene mutation. All patients had resolution of neurological symptoms after anticoagulation treatment. Conclusion CVST may occur in the early stages of NS. There is currently a lack of specific diagnostic indicators to reliably identify the presence of CVST in patients with NS. Children with NS who have neurological symptoms should be promptly evaluated with imaging studies. Whether TRPC6 gene mutation is also a risk factor for CVST remains to be further studied.
Collapse
Affiliation(s)
| | | | | | - Xiaochuan Wu
- Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
14
|
Khizroeva J, Makatsariya A, Vorobev A, Bitsadze V, Elalamy I, Lazarchuk A, Salnikova P, Einullaeva S, Solopova A, Tretykova M, Antonova A, Mashkova T, Grigoreva K, Kvaratskheliia M, Yakubova F, Degtyareva N, Tsibizova V, Gashimova N, Blbulyan D. The Hemostatic System in Newborns and the Risk of Neonatal Thrombosis. Int J Mol Sci 2023; 24:13864. [PMID: 37762167 PMCID: PMC10530883 DOI: 10.3390/ijms241813864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Newborns are the most vulnerable patients for thrombosis development among all children, with critically ill and premature infants being in the highest risk group. The upward trend in the rate of neonatal thrombosis could be attributed to progress in the treatment of severe neonatal conditions and the increased survival in premature babies. There are physiological differences in the hemostatic system between neonates and adults. Neonates differ in concentrations and rate of synthesis of most coagulation factors, turnover rates, the ability to regulate thrombin and plasmin, and in greater variability compared to adults. Natural inhibitors of coagulation (protein C, protein S, antithrombin, heparin cofactor II) and vitamin K-dependent coagulation factors (factors II, VII, IX, X) are low, but factor VIII and von Willebrand factor are elevated. Newborns have decreased fibrinolytic activity. In the healthy neonate, the balance is maintained but appears more easily converted into thrombosis. Neonatal hemostasis has less buffer capacity, and almost 95% of thrombosis is provoked. Different triggering risk factors are responsible for thrombosis in neonates, but the most important risk factors for thrombosis are central catheters, fluid fluctuations, liver dysfunction, and septic and inflammatory conditions. Low-molecular-weight heparins are the agents of choice for anticoagulation.
Collapse
Affiliation(s)
- Jamilya Khizroeva
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Alexander Makatsariya
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Alexander Vorobev
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Victoria Bitsadze
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Ismail Elalamy
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
- Hematology and Thrombosis Center, Tenon Hospital, Sorbonne University, 4 Rue de la Chine, 75020 Paris, France
| | - Arina Lazarchuk
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Polina Salnikova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Sabina Einullaeva
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Antonina Solopova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Maria Tretykova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Alexandra Antonova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Tamara Mashkova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Kristina Grigoreva
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Margaret Kvaratskheliia
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Fidan Yakubova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Natalia Degtyareva
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - Valentina Tsibizova
- Almazov National Medical Research Centre, Health Ministry of Russian Federation, 2 Akkuratova Str., 197341 Saint Petersburg, Russia;
| | - Nilufar Gashimova
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| | - David Blbulyan
- Department of Obstetrics, Gynecology and Perinatal Medicine, N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.M.); (A.V.); (V.B.); (I.E.); (A.L.); (P.S.); (S.E.); (A.S.); (M.T.); (A.A.); (T.M.); (K.G.); (M.K.); (F.Y.); (N.D.); (N.G.); (D.B.)
| |
Collapse
|
15
|
Mishra A, Singh S, Rama Krishna Reddy MM, Anwaar MA, Yadav AS, Ayirebi-Acquah E, Akuma O, Maharjan R, Ugwa DC, Akuma CM, Ikeogu NE. Common Consequences of Uncommon Congenital Heart Disease: Exploring the Trilogy of Fallot With Infective Endocarditis and Cerebral Venous Thrombosis. Cureus 2023; 15:e45244. [PMID: 37842501 PMCID: PMC10576569 DOI: 10.7759/cureus.45244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Trilogy of Fallot (ToF) is a rare congenital heart disease characterized by a combination of atrial septal defect, pulmonary stenosis, and right ventricular hypertrophy. It is more common in females and can cause symptoms such as cyanosis and breathlessness. ToF can lead to complications like thromboembolic events, including infective endocarditis (IE) and cerebral venous thrombosis (CVT). This case study discusses a nine-year-old female with ToF who also had IE and CVT. The patient recovered well following treatment with intravenous beta-lactam and aminoglycoside for IE and subcutaneous low-molecular-weight heparin for CVT.
Collapse
Affiliation(s)
- Anshika Mishra
- Pediatrics, King George's Medical University, Lucknow, IND
| | - Sonali Singh
- Pediatric, King George's Medical University, Lucknow, IND
| | | | - Mohammad Ahsan Anwaar
- Internal Medicine, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | | | | | | | - Reeju Maharjan
- Neurology, V.N. Karazin Kharkiv National University, Kharkiv, UKR
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - David C Ugwa
- Internal Medicine, Richmon Gabriel University, Kingstown, VCT
| | - Chinaza M Akuma
- MPH, College of Health Professions, Chamberlain University, Chicago, USA
| | - Nnenna E Ikeogu
- Internal Medicine, Abia State University Teaching Hospital, Aba, NGA
| |
Collapse
|
16
|
Maiz AM, Chang E, Deveney TK, Kim J, Trobe JD. Subtle imaging signs of sigmoid sinus thrombosis in otitis media ("otitic hydrocephalus"). Radiol Case Rep 2023; 18:3188-3191. [PMID: 37520397 PMCID: PMC10375371 DOI: 10.1016/j.radcr.2023.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/30/2023] [Accepted: 06/18/2023] [Indexed: 08/01/2023] Open
Abstract
A 3-year-old boy developed otitis media, mastoiditis, papilledema, sixth nerve palsy, and increased intracranial pressure. The initial diagnosis was idiopathic intracranial hypertension, but doubt about that diagnosis at such a young age led to imaging reevaluation. When the abnormalities from multiple pulse sequences were aggregated with this clinical input, the correct diagnosis of otitic hydrocephalus emerged, allowing prompt implementation of appropriate treatment to avoid the risk of venous stroke.
Collapse
Affiliation(s)
- Alejandra M. Maiz
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Emily Chang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Tatiana K. Deveney
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - John Kim
- Department of Radiology (Neuroradiology), University of Michigan, Ann Arbor, MI
| | - Jonathan D. Trobe
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
- Department of Neurology, University of Michigan, Ann Arbor, MI
- Kellogg Eye Center, 1000 Wall St, Ann Arbor, MI 48105, USA
| |
Collapse
|
17
|
Kotowski M, Szydlowski J. Otogenic Cerebral Sinus Thrombosis in Children: A Narrative Review. Neurol Ther 2023; 12:1069-1079. [PMID: 37266793 PMCID: PMC10310653 DOI: 10.1007/s40120-023-00499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare entity that remains a diagnostic challenge due to various clinical manifestations and a wide variety of causative agents. Local infections, such as acute (AOM) or chronic otitis media, can play a role in the pathogenesis of CVT. The proximity of the tympanic cavity and temporal bone air cells to the dural venous sinuses predisposes them to secondary thrombosis. The release of inflammatory cytokines and activation of the coagulation pathway in the middle ear space in response to infection may trigger the thrombotic mechanism in venous sinuses of the central nervous system. There is no consensus in the literature concerning the treatment of otogenic cerebral venous sinus thrombosis (CVST). Both the extent of the surgery and the use of anticoagulants are disputable. The aim of the study was to provide a thorough analysis of the literature concerning CVST in patients with AOM and acute mastoiditis (AM). The current surgical and conventional treatment strategies are presented. Special attention has been attached to the predisposing factors, the extent of the surgery, and the role of anticoagulants in the treatment of septic otogenic CVST.
Collapse
Affiliation(s)
- Michal Kotowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572, Poznan, Poland.
| | - Jaroslaw Szydlowski
- Department of Pediatric Otolaryngology, Poznan University of Medical Sciences, 27/33 Szpitalna Street, 60-572, Poznan, Poland
| |
Collapse
|
18
|
Catueno S, Ali S, Barrientos R, Valdez M, Mba N, Sherani F, Bhalala U. Stroke in Pediatric Cancer Patients: A Systematic Review. J Pediatr Hematol Oncol 2023; 45:291-300. [PMID: 36716019 DOI: 10.1097/mph.0000000000002622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/03/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Pediatric cancer patients have an increased risk of stroke. However, there is a knowledge gap regarding stroke in early stages of pediatric cancer. The objective of this project is to describe the current knowledge on stroke in pediatric cancer patients. DESIGN Systematic review. MATERIALS AND METHODS After Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, literature search was conducted in PubMed, Cochrane, and Google Scholar from January 1, 1995, up to February 1, 2022. RESULTS A total of 3499 studies were identified, of which 8 met inclusion criteria. The incidence of stroke in pediatric cancer patients varied between 0.47% and 2.9%, and prevalence between 1% and 3%. The risk factors identified were leukemia diagnosis, cranial radiation, thrombocytopenia, coagulopathy, and infection. There was a higher rate of diagnosis with magnetic resonance imaging than with computed tomography scan. Treatment was inconsistent, and patients with cancer were less likely to receive antithrombotic treatment when compared with patients without cancer. The highest mortality was among hemorrhagic stroke. Recurrence rate was 5% to 19%. CONCLUSIONS The risk for stroke is increased in the pediatric cancer population and can lead to devastating results. The available reports include few patients, with heterogeneous cancer diagnoses and outcomes. Large-scale multicenter studies are needed, focusing on early diagnosis, risk factors, and management strategies of stroke in children with underlying cancer.
Collapse
Affiliation(s)
| | | | | | | | - Nkechi Mba
- Departments of Pediatrics
- Hematology/Oncology, Driscoll Children's Hospital, Corpus Christi
- Department of Pediatrics, Texas A&M University, College Station, TX
| | - Farha Sherani
- Departments of Pediatrics
- Hematology/Oncology, Driscoll Children's Hospital, Corpus Christi
- Department of Pediatrics, Texas A&M University, College Station, TX
| | - Utpal Bhalala
- Departments of Pediatrics
- Anesthesiology and Critical Care Medicine, University of Texas Medical Branch, Galveston
- Department of Pediatrics, Texas A&M University, College Station, TX
| |
Collapse
|
19
|
Guillén-Lozada E, Bartolomé-Benito M, Moreno-Juara Á. Surgical management of mastoiditis with intratemporal and intracranial complications in children. Outcome, complications, and predictive factors. Int J Pediatr Otorhinolaryngol 2023; 171:111611. [PMID: 37352591 DOI: 10.1016/j.ijporl.2023.111611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Intratemporal or intracranial complications of acute mastoiditis are often of significant severity, can be life-threatening, and require prompt and usually aggressive treatment. This study focused on analyzing the outcomes and complications of different surgical techniques used in intracranial and intratemporal complications of acute mastoiditis, the most common complication of acute otitis media. METHODS A retrospective study of pediatric patients with mastoiditis with intratemporal and intracranial complications was designed at the Niño Jesús University Children's Hospital in Madrid, Spain, from 2005 to 2021. RESULTS Of 417 patients with mastoiditis, 112 patients developed intratemporal and intracranial complications, with subperiosteal abscess being the most frequent complication. The most frequently isolated pathogens were Streptococcus pneumoniae, Streptococcus pyogenes, and Fusobacterium necrophorum. The most used surgical technique was myringotomy with placement of transtympanic drainage, in 86.6% of all cases. In patients with intracranial complications, neurosurgical procedures were necessary for 19.2%, with craniotomy with mastoidectomy being the most frequent. Most of the cases evolved favorably, and only 5.4% of the patients required surgical reintervention, being more frequent in intratemporal complications. In terms of complications, we found cases of neutropenia in 3.6%, neurological sequelae in 5.4%, and permanent hearing loss in 2.7%. CONCLUSIONS There was a favorable evolution with a low incidence of reoperation and sequelae within our series. The surgical technique of choice correlated with the severity of the complication. If the mean size of the abscess exceeds 20 mm, incision and drainage, along with myringotomy and tube placement, should be considered as the initial treatment. Closed mastoidectomy should be reserved for deteriorating of clinical evolution or acute mastoiditis with intracranial complications. Intracranial and multiple concomitant complications were associated with a more extended hospital stay, ICU occupancy, neurosurgical intervention, and risk of neurological sequelae and neutropenia. Conversely, intratemporal complications may result in permanent hearing loss.
Collapse
Affiliation(s)
- Enrique Guillén-Lozada
- Otorhinolaryngology Department, Niño Jesus University Children's Hospital, Madrid, Spain.
| | | | - Ángel Moreno-Juara
- Otorhinolaryngology Department, Niño Jesus University Children's Hospital, Madrid, Spain
| |
Collapse
|
20
|
Neumann I, Izcovich A, Aguilar R, Basantes GL, Casais P, Colorio CC, Guillermo Esposito MC, García Lázaro PP, Pereira J, Meillon García LA, Rezende SM, Serrano JC, Tejerina Valle ML, Altuna D, Zúñiga P, Vera F, Karzulovic L, Schünemann HJ. American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematología, Sociedad Peruana de Hematología, and SVH 2023 guidelines for diagnosis of venous thromboembolism and for its management in special populations in Latin America. Blood Adv 2023; 7:3005-3021. [PMID: 36929813 PMCID: PMC10320207 DOI: 10.1182/bloodadvances.2021006534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Implementation of international guidelines in Latin American settings requires additional considerations (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). The purpose of this guideline is to provide evidence-based recommendations about the diagnosis of venous thromboembolism (VTE) and its management in children and during pregnancy. We used the GRADE ADOLOPMENT method to adapt recommendations from 3 American Society of Hematology (ASH) VTE guidelines (diagnosis of VTE, VTE in pregnancy, and VTE in the pediatric population). ASH and 12 local hematology societies formed a guideline panel comprising medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about the diagnosis of VTE and 18 questions about its management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. In comparison with the original guideline, there were significant changes in 2 of 10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9 of 18 management recommendations (4 changed direction and 5 changed strength). This guideline ADOLOPMENT project highlighted the importance of contextualizing recommendations in other settings based on differences in values, resources, feasibility, and health equity impact.
Collapse
Affiliation(s)
- Ignacio Neumann
- School of Medicine, Universidad San Sebastian, Santiago, Chile
| | | | - Ricardo Aguilar
- Servicio de Hematología, Complejo Hospitalario Dr. Arnulfo Arias Madrid, Panama City, Panama
| | | | - Patricia Casais
- Epidemiología Clínica y Evidencia, Instituto de Investigaciones en Salud Pública, Universidad de Buenos Aires, Buenos Aires, Argentina
- Centro de Hematología Pavlovsky, Buenos Aires, Argentina
| | | | | | - Pedro P. García Lázaro
- Faculty of Medicine, Universidad Privada Antenor Orrego, Trujillo, Peru
- Hospital Especializado Víctor Lazarte Echegaray, Trujillo, Peru
| | - Jaime Pereira
- Department of Hematology and Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Suely Meireles Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Diana Altuna
- Pediatric Oncology and Hematology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pamela Zúñiga
- Department of Hematology and Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Vera
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Lorena Karzulovic
- Department of Pediatrics, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
21
|
Otufowora A, Lee C, Mohideen A, DeSena G, Pringle C, Guyer F, Sharma P, Baines T, Carr S. Cerebral venous sinus thrombosis and skull base osteomyelitis as manifestations of cat-scratch disease in a pediatric patient: A case report and literature review. Clin Case Rep 2023; 11:e7561. [PMID: 37361655 PMCID: PMC10288016 DOI: 10.1002/ccr3.7561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
Cat-scratch disease (CSD) is caused by Bartonella henselae and usually presents with regional lymphadenopathy. Skull base osteomyelitis and cerebral venous sinus thrombosis are rarely reported, particularly in immunocompetent children. CSD should be considered in the differential diagnosis of any patient with persistent headaches in the setting of cat exposure.
Collapse
Affiliation(s)
- Ayodeji Otufowora
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Christine Lee
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Aneeb Mohideen
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Grace DeSena
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Charlene Pringle
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Freddie Guyer
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Priya Sharma
- Department of RadiologyCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Torrey Baines
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | - Silvana Carr
- Department of PediatricsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| |
Collapse
|
22
|
Karlin AR, Kumar NK, Vossough A, Abend NS, Ichord RN, Beslow LA. Pediatric Cerebral Sinovenous Thrombosis and Risk for Epilepsy. Pediatr Neurol 2023; 146:85-94. [PMID: 37453223 DOI: 10.1016/j.pediatrneurol.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Cerebral sinovenous thrombosis (CSVT) is a rare form of pediatric stroke with significant morbidity. We determined cumulative incidence and predictors of acute seizures, remote seizures, and epilepsy after pediatric CSVT. METHODS Retrospective analysis of 131 neonates and children with neuroimaging-confirmed CSVT enrolled between 2008 and 2020 from a single-center prospective consecutive cohort. Acute seizures occurred within 7 days of CSVT. Remote seizures occurred >7 days after CSVT. Epilepsy was defined as 2 or more remote seizures at least 24 hours apart. Survival methods determined the incidence of and risk factors for remote seizures and epilepsy. RESULTS Acute seizures occurred in 14/33 neonates (42%) and 19/98 children (19%). Among children, hemorrhage predicted acute seizures (OR 6.6, 95% CI 1.9 to 22.4, P = 0.003). Remote seizures occurred in six neonates; five developed epilepsy. Remote seizures occurred in 14 children; 10 developed epilepsy. In neonates, 1- and 3-year epilepsy-free survival were 86% (95% CI 62% to 95%) and 66% (95% CI 32% to 87%). One- and 3-year epilepsy-free survival in children were 88% (95% CI 76% to 92%) and 84% (95% CI 59% to 86%). In multivariable analysis for children, acute seizures predicted epilepsy (HR 3.8, 95% CI 1.1-13.3, P = 0.039). In both cohorts, Pediatric Stroke Outcome Measure scores at last follow-up were worse in those with epilepsy compared to those without. CONCLUSIONS Acute seizures occurred in approximately one quarter of our cohort and are an epilepsy risk factor in children with CSVT. Neonates and children with epilepsy had worse outcomes than those without.
Collapse
Affiliation(s)
- Alexis R Karlin
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nankee K Kumar
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas S Abend
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca N Ichord
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A Beslow
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
23
|
Torere BE, Weigold J, Aiwuyo HO, Alugba G, Ntukidem O, Tan J. Diagnostic and Therapeutic Challenges of Concurrent Intracranial Hemorrhage and Cerebral Venous Thrombosis in a Patient With Acute Lymphoblastic Leukemia: A Case Report and Literature Review. Cureus 2023; 15:e37482. [PMID: 37187664 PMCID: PMC10177010 DOI: 10.7759/cureus.37482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a cerebrovascular condition due to the thrombosis of cerebral venous sinuses, leading to intracranial hemorrhage, increased intracranial pressure, focal deficit, seizure, toxic edema, encephalopathy, and death. The diagnosis and therapeutic approach of CVST remain challenging because of its highly nonspecific clinical presentation including headaches, seizures, focal neurologic deficits, and altered mental status, etc. Anticoagulation is the mainstay of CVST treatment and should be started as soon as the diagnosis is confirmed. Here, we present the case of a 34-year-old male construction worker who presented to the emergency department with a complaint of right chest wall pain and swelling. He was admitted to the hospital following a diagnosis of anterior chest wall abscess and mediastinitis. During hospitalization, his complete blood count revealed pancytopenia with blast cells, and bone marrow biopsy revealed 78.5% lymphoid blasts by aspirate differential count and hypercellular marrow (100%) with decreased hematopoiesis. He developed concurrent CVST and intracranial hemorrhage while receiving CALGB10403 (vincristine, daunorubicin, pegaspargase, prednisone) with intrathecal cytarabine induction chemotherapy for acute lymphoblastic leukemia (ALL). The patient failed two standard chemotherapy for ALL and achieved remission while on third-line chemotherapy with an anti-CD19 monoclonal antibody, blinatumomab. Although this patient had an MRI scan of the brain with multiple follow-up non-contrast CT scans, it was CT angiography that revealed CVST. This showed the diagnostic challenge in CVST, with CT and MRI venography having excellent sensitivity in diagnosing CVST. Risk factors for CVST in our patient were ALL and its intensive induction chemotherapy with pegaspargase.
Collapse
Affiliation(s)
| | - Joseph Weigold
- Internal Medicine, North Mississippi Medical Center, Tupelo, USA
| | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | | | | | - Jiahuai Tan
- Hematology and Oncology, North Mississippi Medical Center, Tupelo, USA
| |
Collapse
|
24
|
Beer M, Mentzel HJ, Steinborn M, Schaal MC. Acute care diagnostics in children for general radiologists - not alone in the hospital at night. ROFO-FORTSCHR RONTG 2023; 195:205-216. [PMID: 36261070 DOI: 10.1055/a-1948-1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Radiologic care for children and adolescents during night and weekend shifts is challenging. This is especially true when a dedicated pediatric radiology front or background service is not available. METHODS The purpose of this review is to present the approach, the most relevant diagnoses, and their differential diagnoses based on four common example cases - abdominal pain, respiratory/chest pain, headache, and refusal to walk. Essentials such as clinical classification (e. g., disease dynamics) and practical instructions (e. g., necessity of acute cross-sectional imaging) are presented. RESULTS AND CONCLUSION For the abdomen, appendicitis ranks first among acute diseases. Other important diseases are intussusception and volvulus. Far more frequently, however, gastroenteritis is the cause of abdominal pain. Usually no imaging is required in this case. In unclear clinical situations, ultrasound may be indicated. In suspected pulmonary infections, chest imaging is limited to inconclusive cases and suspicion of complications such as pleural empyema. Major emergencies include (spontaneous) pneumothorax and aspiration. Headache is a common symptom. Immediate imaging is only necessary in cases of suspected acute inflammatory (meningitis/encephalitis) or vascular disease (e. g., hemorrhage due to vascular malformations). MRI is the primary imaging modality in these cases. Restricted walking/refusal to walk is a classic nonspecific sign, particularly of acute musculoskeletal disease, especially in younger children. Clinical examination is essential to narrow down the field of investigation. Besides the frequent and symptomatic coxitis fugax, the rare but serious (septic) arthritis/osteomyelitis must not be overlooked. KEY POINTS · Radiological care of children and adolescents is challenging, especially during night and weekend shifts.. · However, in close cooperation with the referring colleagues/clinics, the appropriate approach can be effectively determined even if the symptoms are not clear.. · The selection of the optimal imaging method is based on guidance and guidelines, but also on the condition of the child/adolescent.. · A silent or whimpering child is cause for alarm.. CITATION FORMAT · Beer M, Mentzel H, Steinborn M et al. Acute care diagnostics in children for general radiologists - not alone at night in the hospital. Fortschr Röntgenstr 2023; 195: 205 - 216.
Collapse
Affiliation(s)
- Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Hans-Joachim Mentzel
- Department of Radiology/Division of Paediatric Radiology, Jena University Hospital, Jena, Germany.,President, German Society for Pediatric Radiology, Jena, Germany
| | - Marc Steinborn
- Institute for Diagnostic and Interventional Radiology and Pediatric Radiology, Munich Municipal Hospital Group, Munchen, Germany
| | | |
Collapse
|
25
|
Vu A, Schoonover A, Lanphear J, Benner C. An epidural brain abscess and thrombus in the superior sagittal sinus in a 12 year-old with sinusitis. Am J Emerg Med 2023; 65:218.e5-218.e7. [PMID: 36581509 DOI: 10.1016/j.ajem.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Upper respiratory infections can be complicated by acute bacterial sinusitis in pediatric patients, and usually resolve with antibiotic therapy (DeMuri and Wald, 2011). However, intracranial complications such as: epidural abscess, meningitis and more rarely cerebral sinus venous thrombosis (CSVT) can occur (Germiller et al., 2006). We report an unusual case of sinusitis complicated by an epidural abscess and later a CSVT in a young previously healthy patient. CASE DESCRIPTION A 12-year-old female presented to the emergency department with a 9-day history of headaches and a 3-day history of fevers, rigors, nasal congestion and nonproductive cough. She later tested positive for Covid-19. CT and MRI showed extensive paranasal sinus disease and a right frontal epidural collection. MRV showed no sinovenous thrombosis. Washout and burr hole drainage alongside endoscopic sinus surgery was completed and post-op imaging showed evacuation of the epidural abscess with a small residual collection. Six days after the procedure, she experienced worsening headaches and MRV showed a nonocclusive thrombus in the superior sagittal sinus, which was treated with anticoagulation therapy. Upon follow-up, the patient showed improvement of the sinusitis, abscess and thrombus. CONCLUSION This specific case encourages clinicians to be aware of complications, though rare, and to diagnose and treat sinusitis cases quickly. It is also important to be aware of any risk factors for thrombus formation, including an inflammatory and hypercoagulable state. In the patient's case, it was perceived that the CSVT was provoked due to the patient's Covid-19 infection, abscess, and sinus disease.
Collapse
Affiliation(s)
- Annie Vu
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Amanda Schoonover
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Jackson Lanphear
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - Christopher Benner
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA; Spectrum Health Medical Group, Grand Rapids, MI, USA.
| |
Collapse
|
26
|
Harrar DB, Sun LR, Segal JB, Lee S, Sansevere AJ. Neuromonitoring in Children with Cerebrovascular Disorders. Neurocrit Care 2023; 38:486-503. [PMID: 36828980 DOI: 10.1007/s12028-023-01689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/31/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Cerebrovascular disorders are an important cause of morbidity and mortality in children. The acute care of a child with an ischemic or hemorrhagic stroke or cerebral sinus venous thrombosis focuses on stabilizing the patient, determining the cause of the insult, and preventing secondary injury. Here, we review the use of both invasive and noninvasive neuromonitoring modalities in the care of pediatric patients with arterial ischemic stroke, nontraumatic intracranial hemorrhage, and cerebral sinus venous thrombosis. METHODS Narrative review of the literature on neuromonitoring in children with cerebrovascular disorders. RESULTS Neuroimaging, near-infrared spectroscopy, transcranial Doppler ultrasonography, continuous and quantitative electroencephalography, invasive intracranial pressure monitoring, and multimodal neuromonitoring may augment the acute care of children with cerebrovascular disorders. Neuromonitoring can play an essential role in the early identification of evolving injury in the aftermath of arterial ischemic stroke, intracranial hemorrhage, or sinus venous thrombosis, including recurrent infarction or infarct expansion, new or recurrent hemorrhage, vasospasm and delayed cerebral ischemia, status epilepticus, and intracranial hypertension, among others, and this, is turn, can facilitate real-time adjustments to treatment plans. CONCLUSIONS Our understanding of pediatric cerebrovascular disorders has increased dramatically over the past several years, in part due to advances in the neuromonitoring modalities that allow us to better understand these conditions. We are now poised, as a field, to take advantage of advances in neuromonitoring capabilities to determine how best to manage and treat acute cerebrovascular disorders in children.
Collapse
Affiliation(s)
- Dana B Harrar
- Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
| | - Lisa R Sun
- Divisions of Pediatric Neurology and Vascular Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Bradley Segal
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Arnold J Sansevere
- Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA
| |
Collapse
|
27
|
Sarecka-Hujar B, Gujski M, Maluchnik M, Bartosiński J, Chłoń-Domińczak A, Kopyta I, Raczkiewicz D. Study of 52 Pediatric Patients Who Required 78 Hospital Admissions for Cerebral Venous Sinus Thrombosis from 2013 to 2020 Using Data from the Polish National Health Fund Registry. Med Sci Monit 2023; 29:e939176. [PMID: 36726299 PMCID: PMC9904331 DOI: 10.12659/msm.939176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) in children is a rare disease with a complex, multifactorial etiopathogenesis. The Polish National Health Fund (NHF) Registry [Narodowy Fundusz Zdrowia (NFZ)], contains health insurance data from all 16 national provinces, or voivodeships. This study used data from the Polish NHF Registry to evaluate 52 pediatric patients who required 78 hospital admissions for CVST from 2013 to 2020. MATERIAL AND METHODS The data in the Polish NHF Registry were acquired based on the disease code I67.6 from the International Classification of Diseases, Tenth Revision (ICD-10), and the patients' age (up to 18 years old). RESULTS We identified 78 hospitalizations of 52 pediatric patients due to CVST in Poland from 2013 to 2020 (63.5% boys and 36.5% girls, mean age 9.7±5.8 years old). The mean duration of hospitalization was 10.5±11.7 days, the mean cost of hospitalization was 3273±2191 Polish zloty (PLN). The most common age subgroup was adolescents (27%). Ten percent of patients were hospitalized in a region other than their region of residence. The duration and cost of hospitalization were positively correlated with each other (r=0.512, P<0.001). The most common type of admission was an emergency (51%), and the most common discharge was referral for further outpatient treatment (50%). CONCLUSIONS Polish registry data showed that from 2013 to 2020, CVST was more commonly diagnosed in male adolescents from 15 to 18 years of age who presented as emergency hospital admissions. There were regional differences in incidence and duration of hospital stay and healthcare costs between patients.
Collapse
Affiliation(s)
- Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Sosnowiec, Poland
| | - Mariusz Gujski
- Department of Public Health, Medical University of Warsaw, Warsaw, Poland
- Department of Analysis and Strategy, Ministry of Health, Warsaw, Poland
| | - Michał Maluchnik
- Department of Adult Neurology, Medical University of Gdańsk and University Clinical Centre, Gdańsk, Poland
| | - Jarosław Bartosiński
- Department of Anesthesiology and Intensive Therapy, Independent Public Clinical Hospital No. 4 in Lublin, Lublin, Poland
| | - Agnieszka Chłoń-Domińczak
- Institute of Statistics and Demography, Collegium of Economic Analyses, SGH Warsaw School of Economics, Warsaw, Poland
| | - Ilona Kopyta
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Dorota Raczkiewicz
- Department of Medical Statistics, School of Public Health, Center of Postgraduate Medical Education, Warsaw, Poland
| |
Collapse
|
28
|
Narcy L, Durand S, Grimaud M, Leboucq N, Grevent D, Cambonie G, Couloigner V, Rivier F, Meyer P, Kossorotoff M. Cerebral sinovenous thrombosis associated with head/neck infection in children: Clues for improved management. Dev Med Child Neurol 2023; 65:215-222. [PMID: 35765978 DOI: 10.1111/dmcn.15331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/11/2022] [Accepted: 06/02/2022] [Indexed: 01/06/2023]
Abstract
AIM To compare paediatric patients with cerebral sinovenous thrombosis (CSVT) with and without head/neck infection to improve management of the condition. METHOD We conducted a bicentric retrospective study of consecutive children (neonates excluded) with radiologically confirmed CSVT, comparing children with a concurrent head/neck infection and children with other causes. RESULTS A total of 84 consecutive patients (46 males and 38 females) with a median age of 4 years 6 months (range 3 months-17 years 5 months) were included. Associated head/neck infection was identified in 65.4% of cases and represented the main identified CSVT aetiology. Children in the head/neck infection group displayed a milder clinical presentation and less extensive CSVT. Median time to complete recanalization was significantly shorter in this group (89 days [interquartile range 35-101] vs 112.5 days [interquartile range 83-177], p = 0.005). These findings were even more pronounced in the subgroup of patients with otogenic infection and no neurological sign. INTERPRETATION As CSVT in the setting of an otogenic infection and no neurological sign seems to represent a milder condition with a shorter course, these results suggest adapting current recommendations: consider earlier control imaging in paediatric otogenic CSVT, and shorter anticoagulant treatment if recanalization is obtained. WHAT THIS PAPER ADDS Children with cerebral sinovenous thrombosis related to head/neck infections have a milder clinical presentation. They also have a shorter recanalization time, especially if there is otogenic infection without neurological symptoms.
Collapse
Affiliation(s)
- Lucie Narcy
- Paediatric Neurology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France.,Sorbonne Université, Paris, France
| | - Sabine Durand
- Paediatric and Neonatal Intensive Care Unit, CHU Arnaud de Villeneuve, Montpellier, France
| | - Marion Grimaud
- Paediatric Intensive Care Unit, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboucq
- Paediatric Imaging Department, CHU Arnaud de Villeneuve, Montpellier, France
| | - David Grevent
- Paediatric Imaging Department, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - Gilles Cambonie
- Paediatric and Neonatal Intensive Care Unit, CHU Arnaud de Villeneuve, Montpellier, France
| | - Vincent Couloigner
- Paediatric Otorhinolaryngology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France
| | - François Rivier
- Paediatric Neurology Department, Phymedexp, Montpellier University, Inserm, CNRS, University Hospital Montpellier, Montpellier, France
| | - Pierre Meyer
- Paediatric Neurology Department, Phymedexp, Montpellier University, Inserm, CNRS, University Hospital Montpellier, Montpellier, France
| | - Manoelle Kossorotoff
- Paediatric Neurology Department, APHP, University Hospital Necker-Enfants Malades, Paris, France.,French Centre for Paediatric Stroke, APHP, University Hospital Necker-Enfants Malades, Paris, France
| |
Collapse
|
29
|
Grigore I, Miron I, Gavrilovici C, Lupu VV, Antal DC, Schreiner TG, Prazaru C, Lupu A, Dragan F, Grigore E. SARS-CoV-2 Possible Etiology of Cerebral Venous Thrombosis in a Teenager: Case Report and Review of Literature. Viruses 2023; 15:v15020405. [PMID: 36851619 PMCID: PMC9965073 DOI: 10.3390/v15020405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Cerebral venous thrombosis in pediatric patient has a varied etiology. The authors present the case of a teenager who, since the debut of SARS-CoV-2 infection, has accused intermittent right side hemicrania, which has become persistent in association with nausea and vomiting since the 5th day of quarantine. She was hospitalized in the 9th day since the debut. Neuroimaging revealed extended venous cerebral thrombosis affecting the right sigmoid sinus, the transverse sinus bilaterally, the confluence of the transverse sinuses and the right internal jugular vein. The evolution was favorable under anticoagulant and symptomatic treatment. Laboratory tests excluded other etiological causes for the cerebral venous thrombosis, thus the authors consider that cerebral thrombosis is a possible complication of SARS-CoV-2 infection in teenagers.
Collapse
Affiliation(s)
- Ioana Grigore
- “St. Mary” Children Emergency Hospital, 700309 Iasi, Romania
| | - Ingrith Miron
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cristina Gavrilovici
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Vasile Valeriu Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (V.V.L.); (A.L.)
| | - Dorin Cristian Antal
- Neurology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Catalin Prazaru
- “St. Mary” Children Emergency Hospital, 700309 Iasi, Romania
| | - Ancuta Lupu
- Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Correspondence: (V.V.L.); (A.L.)
| | - Felicia Dragan
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Ecaterina Grigore
- Faculty of General Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| |
Collapse
|
30
|
Malone LA, Levy TJ, Peterson RK, Felling RJ, Beslow LA. Neurological and Functional Outcomes after Pediatric Stroke. Semin Pediatr Neurol 2022; 44:100991. [PMID: 36456032 DOI: 10.1016/j.spen.2022.100991] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022]
Abstract
Pediatric stroke results in life-long morbidity for many patients, but the outcomes can vary depending on factors such as age of injury, or mechanism, size, and location of stroke. In this review, we summarize the current understanding of outcomes in different neurological domains (eg, motor, cognitive, language) for children with stroke of different mechanisms (ie, arterial ischemic stroke, cerebral sinus venous thrombosis, and hemorrhagic stroke), but with a focus on World Health Organization International Classification for Functioning, Disability, and Health (ICF-CY) framework for measuring health and disability for children and youth. We describe outcomes for the population as a whole and certain factors that may further refine prognostication.
Collapse
Affiliation(s)
- Laura A Malone
- Kennedy Krieger Institute, Baltimore, MD; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Todd J Levy
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rachel K Peterson
- Kennedy Krieger Institute, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lauren A Beslow
- The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
31
|
Otite FO, Vanguru H, Anikpezie N, Patel SD, Chaturvedi S. Contemporary Incidence and Burden of Cerebral Venous Sinus Thrombosis in Children of the United States. Stroke 2022; 53:e496-e499. [DOI: 10.1161/strokeaha.122.039822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background:
The incidence of cerebral venous thrombosis (CVT) in children of the United States is unknown, and it is uncertain how the burden of CVT hospitalizations in children changed over the last decade.
Methods:
We conducted a retrospective cohort study using the State Inpatient Database and Kid’s inpatient database. All new CVT cases in children (0–19 years) in the New York 2006 to 2018 State Inpatient Database (n=705), and all cases of CVT in the entire US contained in the 2006 to 2019 Kid’s inpatient database (weighted n=6115) were identified using validated
International Classification of Diseases (ICDs
) codes. Incident counts were combined with census data to compute incidence. Between-group differences in incidence were tested using 2-proportions
Z
-test, and Joinpoint regression was used to trend incidence over time.
Results:
Across the study period, 48.2% of all incident CVT cases and 44.6% of all CVT admissions nationally were in girls. Of all incident cases, 27.2% were infants and 65.8% of these infants were neonates. Average incidence across the study period was (1.1/100 000/year, SE:0.04) but incidence in infants (6.4/100 000/year) was at least 5 times the incidence in other age groups (1–4 years: 0.7/100 000/year, 15–19 years: 1.2/100 000/year). Incidence and national burden of CVT admissions was higher in girls in adolescents 15 to 19 years, but overall burden was higher in boys in other age groups. Age- and sex-standardized CVT incidence increased by 3.8% annually (95% CI, 0.2%–7.6%), while the overall burden of admissions increased by 4.9% annually (95% CI, 3.6%–6.2%).
Conclusions:
CVT incidence in New York and national burden of CVT increased significantly over the last decade.
Collapse
Affiliation(s)
- Fadar Oliver Otite
- Department of Neurology, Upstate Medical University, Syracuse, NY (F.O.O.)
| | - Husitha Vanguru
- Department of Neurology, University of Kansas Medical Center, Kansas City (H.V.)
| | - Nnabuchi Anikpezie
- Department of Population Health Science, University of Mississippi Medical Center, Jackson (N.A.)
| | - Smit D. Patel
- Department of Neurology, University of Connecticut (S.D.P.)
| | | |
Collapse
|
32
|
Sharaf MA, Mohammed MZ. Neurological complications in Egyptian children with nephrotic syndrome. J Paediatr Child Health 2022; 58:1168-1173. [PMID: 35218592 DOI: 10.1111/jpc.15927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022]
Abstract
AIM This study aimed at describing the incidence, risk factors and outcomes for neurological manifestations in Egyptian children with nephrotic syndrome (NS) and determining correctable factors that could lower the risk for these complications. METHODS The medical records of all children with NS who presented to Nephrology clinic, Ain Shams University Children hospital (a tertiary hospital) from April 2018 to April 2020 were reviewed retrospectively for the clinical progression of NS with special emphasis on neurological manifestations, contributory risk factors and outcomes. RESULTS Among 67 children with NS, 13 children had neurological events. Seven patients had posterior reversible encephalopathy syndrome (PRES), four patients suffered from cerebral sinovenous thrombosis (CSVT) and two patients presented with arterial strokes. Hypertension was significantly higher in patients with NS and neurological manifestations (NS/N+) when compared to patients with NS without neurological manifestations (NS/N-) (76.9% vs. 40.7%; P = 0.019). NS/N+ group had significantly higher levels of triglycerides and cholesterol (209.7 ± 41.4 and 323.6 ± 40.7 in NS/N+ vs. 181.96 ± 31.8 and 243.8 ± 38.8 in NS/N-). Prothrombotic tendency was significantly higher in NS/N+ group as compared to NS/N- group. All patients recovered totally except patients with arterial strokes who had residual hemiparesis. CONCLUSION Neurological complications in form of PRES, CSVT and arterial strokes were detected in children with NS. The outcome was favourable in most of the cases. Investment in parental education about the importance of follow up of blood pressure, dietary modification and good hydration could help in minimising the risk of patients with NS to develop neurological complications.
Collapse
Affiliation(s)
- Mohammad A Sharaf
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maha Z Mohammed
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
33
|
Cerebral venous thrombosis in children an 18-year review of a Portuguese hospital. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
34
|
Al Sharie AH, Al Zu'bi YO, Al-Sweedan S, Khasawneh RA, Altamimi E. Successful management of dural venous sinus thrombosis secondary to ulcerative colitis in a pediatric patient: A case report. Radiol Case Rep 2022; 17:2162-2166. [PMID: 35479968 PMCID: PMC9036061 DOI: 10.1016/j.radcr.2022.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 11/19/2022] Open
Abstract
Cerebral venous sinus thrombosis secondary to inflammatory bowel disease is a clinically rare and challenging entity with serious sequela. We preset a case of a 15-year-old female patient who was recently diagnosed with ulcerative colitis and had been suffering from headache for 4 days duration. During the diagnostic workup, computed tomography (CT) venography revealed Dural venous sinus thrombosis in the left transverse sinus extending into the left sigmoid sinus and the upper third of the left internal jugular vein as well as into the sinus confluence with non–occlusive filling defects in the superior sagittal sinus. Anticoagulant therapy with enoxaparin was initiated and the patient is being monitored in an outpatient setting regularly. Post-discharge disease course was uneventful. CT venography performed after 3 months illustrated partial recanalization of both left transverse and sigmoid sinuses. CVST is a rare extraintestinal manifestation of ulcerative colitis with significant morbidity and mortality which requires a high level of suspicion to establish a clear diagnosis. In spite the fact that CVST is rare, it should be ruled out in inflammatory bowel disease patients with new onset seizures, headache, along with focal, and non–focal neurologic symptoms.
Collapse
Affiliation(s)
- Ahmed H. Al Sharie
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Yazan O. Al Zu'bi
- Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Suleimman Al-Sweedan
- Department of Pediatric, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ruba A. Khasawneh
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Eyad Altamimi
- Department of Pediatric, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
- Corresponding author.
| |
Collapse
|
35
|
So V, Watts M, Moharir M, Vargas C, Adrian-Gutierrez J, Sakran M, Elmekkawi A, Duong H, Kukreti V. 2-year-old girl with anemia and irritability. Paediatr Child Health 2022; 27:65-67. [DOI: 10.1093/pch/pxab046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/25/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vincent So
- Department of Pediatrics, School of Medicine, Queen’s University, Kingston, Ontario, Canada
- Queen’s School of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Maria Watts
- Department of Pediatrics, School of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Pediatrics, Lakeridge Hospital Oshawa, Lakeridge Health, Oshawa, Ontario, Canada
| | - Mahendranath Moharir
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - Carolina Vargas
- Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - Javier Adrian-Gutierrez
- Department of Pediatrics, School of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Pediatrics, Lakeridge Hospital Oshawa, Lakeridge Health, Oshawa, Ontario, Canada
| | - Mahmoud Sakran
- Department of Pediatrics, School of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Pediatrics, Lakeridge Hospital Oshawa, Lakeridge Health, Oshawa, Ontario, Canada
| | - Amir Elmekkawi
- Department of Pediatrics, School of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Pediatrics, Lakeridge Hospital Oshawa, Lakeridge Health, Oshawa, Ontario, Canada
| | - Heather Duong
- Department of Pediatrics, School of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Pediatrics, Lakeridge Hospital Oshawa, Lakeridge Health, Oshawa, Ontario, Canada
| | - Vinay Kukreti
- Department of Pediatrics, School of Medicine, Queen’s University, Kingston, Ontario, Canada
- Department of Pediatrics, Lakeridge Hospital Oshawa, Lakeridge Health, Oshawa, Ontario, Canada
| |
Collapse
|
36
|
Karakas C, Hajiyev Y, Skrehot HC, Kralik SF, Lambert EM, Pehlivan D. Clinical Profile and Long-Term Outcomes in Pediatric Cavernous Sinus Thrombosis. Pediatr Neurol 2022; 130:28-40. [PMID: 35306302 DOI: 10.1016/j.pediatrneurol.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/23/2021] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric cavernous sinus thrombosis (CST) is a rare condition with limited data regarding its clinical characteristics and long-term outcomes. The objective of this study was to describe the clinical and radiologic features, diagnostic evaluation, management, and long-term prognosis and to identify clinical variables associated with long-term outcomes in pediatric CST. METHODS A retrospective chart review of patients younger than 18 years diagnosed with a CST between 2004 and 2018 at a single center was conducted. RESULTS We identified 16 (M:F = 10:6) children with CST with a mean age of 7.6 years (10 days to 15 years) and average follow-up duration of 29 months (3 weeks to 144 months). The most common symptom and examination finding at presentation was eyelid swelling (n = 8). Six patients had bilateral CST. The most common etiologies were sinusitis (n = 5) and orbital cellulitis (n = 5). Treatments included antibiotics (n = 14), anticoagulation (n = 11), and surgery (n = 5). Only one patient died due to intracranial complications. Twelve patients had a normal examination at follow-up. None of the clinical variables including age (P = 0.14), gender (P = 0.09), use of antibiotics (P = 1.00) or anticoagulation (P = 1.00), surgery (P = 0.28), parenchymal abnormalities (P = 0.30), additional cerebral venous thrombosis (P = 0.28), and early versus late commencing of anticoagulation (P = 1.00) were significant when comparing patients with full/partial resolution versus those with no resolution of thrombosis on follow-up neuroimaging. CONCLUSIONS Our study is one of the largest cohorts with the longest follow-up data for the pediatric CST. Most of our patients had favorable outcomes at follow-up. We found no statistical difference between clinical variables when comparing patients with full/partial resolution versus those with no resolution of thrombosis on follow-up neuroimaging.
Collapse
Affiliation(s)
- Cemal Karakas
- Division of Pediatric Neurology, Department of Neurology, University of Louisville, Norton Children's Medical Group, Louisville, Kentucky
| | - Yusif Hajiyev
- Department of Pediatric Otolaryngology, Baylor College of Medicine, Houston, Texas
| | - Henry C Skrehot
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Stephen F Kralik
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Elton M Lambert
- Department of Pediatric Otolaryngology, Baylor College of Medicine, Houston, Texas
| | - Davut Pehlivan
- Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.
| |
Collapse
|
37
|
Salman R, Chong I, Amans M, Hui F, Desai N, Huisman TAGM, Tran B. Pediatric tinnitus: The role of neuroimaging. J Neuroimaging 2022; 32:400-411. [PMID: 35307901 DOI: 10.1111/jon.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
Tinnitus is defined as the perception of sound without an external source and can be categorized as either pulsatile or nonpulsatile (ie, continuous). A variety of etiologies have been reported to cause pediatric tinnitus, many with long-lasting implications due to hearing and concentration impairments. Therefore, imaging can be an essential part of the accurate and timely diagnosis of treatable etiologies. We describe neuroimaging findings in different etiologies of pediatric tinnitus. Etiologies of pulsatile tinnitus are frequently vascular in nature and include vascular loops, congenital vascular anomalies or variants, high riding jugular bulbs with or without a jugular bulb diverticulum, idiopathic intracranial hypertension, aneurysms, internal auditory canal hemangiomas, and petrous apex cephaloceles. Etiologies of continuous tinnitus frequently affect the middle/inner ear structures and include vestibular schwannomas, cholesteatomas, trauma, Chiari malformations, and labyrinthitis ossificans. CT and MR are often complementary modalities: CT is better suited to evaluate the integrity of the temporal osseous structures and MR is better suited to evaluate the vestibulocochlear nerve and to assess for the presence of any masses or malformations. Prompt diagnosis of the etiology of tinnitus in pediatric patients is important to avoid any potential long-term developmental impairments. In the approach to pediatric tinnitus, categorizing the symptoms as either pulsatile versus nonpulsatile and then being aware of the possible causes and imaging findings of either can assist both the clinician and the radiologist in making an expeditious diagnosis.
Collapse
Affiliation(s)
- Rida Salman
- Edward B. Singleton Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Insun Chong
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew Amans
- Department of Radiology, University of California, San Francisco, San Francisco, California, USA
| | - Ferdinand Hui
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Nilesh Desai
- Edward B. Singleton Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Brandon Tran
- Edward B. Singleton Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| |
Collapse
|
38
|
Sporns PB, Fullerton HJ, Lee S, Kim H, Lo WD, Mackay MT, Wildgruber M. Childhood stroke. Nat Rev Dis Primers 2022; 8:12. [PMID: 35210461 DOI: 10.1038/s41572-022-00337-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/09/2023]
Abstract
Stroke is an important cause of neurological morbidity in children; most survivors have permanent neurological deficits that affect the remainder of their life. Stroke in childhood, the focus of this Primer, is distinguished from perinatal stroke, defined as stroke before 29 days of age, because of its unique pathogenesis reflecting the maternal-fetal unit. Although approximately 15% of strokes in adults are haemorrhagic, half of incident strokes in children are haemorrhagic and half are ischaemic. The causes of childhood stroke are distinct from those in adults. Urgent brain imaging is essential to confirm the stroke diagnosis and guide decisions about hyperacute therapies. Secondary stroke prevention strongly depends on the underlying aetiology. While the past decade has seen substantial advances in paediatric stroke research, the quality of evidence for interventions, such as the rapid reperfusion therapies that have revolutionized arterial ischaemic stroke care in adults, remains low. Substantial time delays in diagnosis and treatment continue to challenge best possible care. Effective primary stroke prevention strategies in children with sickle cell disease represent a major success, yet barriers to implementation persist. The multidisciplinary members of the International Pediatric Stroke Organization are coordinating global efforts to tackle these challenges and improve the outcomes in children with cerebrovascular disease.
Collapse
Affiliation(s)
- Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland.,Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heather J Fullerton
- Departments of Neurology and Pediatrics, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Helen Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Center for Cerebrovascular Research, University of California at San Francisco, San Francisco, CA, USA
| | - Warren D Lo
- Departments of Pediatrics and Neurology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Moritz Wildgruber
- Department of Radiology, University Hospital Munich, LMU Munich, Munich, Germany.
| |
Collapse
|
39
|
Kalyva N, Mousafeiris VK, Giannakopoulos A. Sigmoid Sinus Thrombosis As Complication of Otitis Media in a 3-Year-Old Boy: Case Report and Review of the Literature. Cureus 2022; 14:e22262. [PMID: 35340493 PMCID: PMC8931448 DOI: 10.7759/cureus.22262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/11/2022] Open
Abstract
Sigmoid sinus thrombosis is a relatively rare, but severe complication of acute otitis media and mastoiditis among other conditions. We report a case of a 3-year-old boy with a history of recurrent acute otitis media which was initially partially treated with antibiotics for 1 month before his admission to our department for high fever and headache. Although initially, no signs of central nervous system (CNS) involvement were present, clinical suspicion for CNS pathology led our whole work-up to conclude the diagnosis of sigmoid sinus thrombosis. The patient was subsequently treated with intravenous antibiotics, anticoagulation therapy and also underwent myringotomy, bilateral tympanostomy tube placement, and mastoidectomy. Cerebral sinus thrombosis is a life-threatening condition that usually complicates the neglected acute otitis media or mastoiditis. Optimal treatment includes antibiotic therapy, hydration, and pain management, with the debatable role of anticoagulation therapy and mastoidectomy.
Collapse
|
40
|
The management of elevated intracranial pressure and sinus vein thrombosis associated with mastoiditis: the experience of eighteen patients. Childs Nerv Syst 2022; 38:421-428. [PMID: 34713346 DOI: 10.1007/s00381-021-05402-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cerebral sinus vein thrombosis (CSVT) associated with acute mastoiditis is a rare complication of acute otitis media. Elevated intracranial pressure (ICP) frequently occurs secondary to CSVT. The study aims to review the 5 years of experience of four medical centres to treat sigmoid sinus thrombosis and elevated intracranial pressure in children. METHODS Patients with CSVT that developed secondary mastoiditis from 2016 through 2021 were evaluated in four centres from Turkey. Patients diagnosed with a preceding or synchronous mastoiditis and intracranial sinus thrombosis were included in the study. Magnetic resonance imaging (MRI), magnetic resonance venography (MRV), ICP measurements, ophthalmological examinations, thrombophilia studies and treatments for increased ICP have also been recorded. RESULTS The study group comprises 18 children. Twelve patients were diagnosed with right-sided, six patients with left-sided sinus vein thrombosis. All of the patients had ipsilateral mastoiditis. The most common presenting symptoms were fever, ear pain, headache, visual disorders and vomiting. The most encountered neurologic findings were papilledema, strabismus and sixth cranial nerve palsy. ICP was over 20 cm H2O in eleven patients. Anticoagulant treatment, antibiotics, pressure-lowering lumbar puncture and lumboperitoneal shunt were among the treatment modalities. CONCLUSION Elevated ICP can damage the brain and optic nerve irreversibly, without treatment. For treating elevation of ICP associated with cerebral sinus thrombosis, pressure-lowering lumbar puncture (LP), acetazolamide therapy, optic nerve sheath fenestration (ONSF) and cerebrospinal fluid (CSF)-shunting procedures are suggested in case of deteriorated vision.
Collapse
|
41
|
Vaslow DF. Chronic subdural hemorrhage predisposes to development of cerebral venous thrombosis and associated retinal hemorrhages and subdural rebleeds in infants. Neuroradiol J 2022; 35:53-66. [PMID: 34167377 PMCID: PMC8826291 DOI: 10.1177/19714009211026904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
For infants presenting with subdural hemorrhage, retinal hemorrhage, and neurological decline the "consensus" opinion is that this constellation represents child abuse and that cerebral venous sinus thrombosis and cortical vein thrombosis is a false mimic. This article contends that this conclusion is false for a subset of infants with no evidence of spinal, external head, or body injury and is the result of a poor radiologic evidence base and misinterpreted data. Underdiagnosis of thrombosis is the result of rapid clot dissolution and radiologic under recognition. A pre-existing/chronic subdural hemorrhage predisposes to development of venous sinus thrombosis/cortical vein thrombosis, triggered by minor trauma or an acute life-threatening event such as dysphagic choking, variably leading to retinal and subdural hemorrhages and neurologic decline. These conclusions are based on analysis of the neuroradiologic imaging findings in 11 infants, all featuring undiagnosed cortical vein or venous sinus thrombosis. Subtle neuroradiologic signs of and the mechanisms of thrombosis are discussed. Subarachnoid hemorrhage from leaking thrombosed cortical veins may be confused with acute subdural hemorrhage and probably contributes to the development of retinal hemorrhage ala Terson's syndrome. Chronic subdural hemorrhage rebleeding from minor trauma likely occurs more readily than bleeding from traumatic bridging vein rupture. Radiologists must meet the challenge of stringent evaluation of neuro imaging studies; any infant with a pre-existing subdural hemorrhage presenting with neurologic decline must be assumed to have venous sinus or cortical vein thrombosis until proven otherwise.
Collapse
Affiliation(s)
- Dale F Vaslow
- Department of Radiology, Harry S.
Truman Veterans Administration Hospital, Columbia, MO, USA,Dale F Vaslow, 2504 Lenox Place, Columbia,
MO 65203, USA.
| |
Collapse
|
42
|
Lin TY, Chien KH. Delayed Onset Bilateral Papilledema in a Young Boy's Eyes after Trauma. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010140. [PMID: 35056449 PMCID: PMC8780981 DOI: 10.3390/medicina58010140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare venous thromboembolic disease that affects young adults in their thirties, with a female predilection. Head trauma accounts for only 1-3% of cases among possible etiologies. Here, we present a particular case of trauma-related CVST with delayed-onset symptoms and signs in a young boy. A 12-year-old boy presented to the emergency department with non-specific visual symptoms 11 days after head trauma. Apart from mild-grade disc swelling in the right eye and dyschromatopsia in both eyes, no significant findings were revealed during physical examinations and a non-contrast cranial computed tomography (CT) scan. Unfortunately, the patient suffered multiple seizure attacks the following day. Trauma-related CVST, complicated by delayed-onset increased intracranial pressure, and bilateral papilledema were finally diagnosed. Physicians need increased awareness of a possible CVST diagnosis if a patient with a history of head trauma shows persistent or worsening neurological symptoms despite negative results on serial non-contrast cranial CT scans.
Collapse
|
43
|
Almeida LCA, Costa BS, de Lima FBF. Cerebral venous sinus thrombosis as a consequence of shunt hyperdrainage: a proposal of the pathophysiological mechanism and case report. Childs Nerv Syst 2022; 38:25-32. [PMID: 34562131 DOI: 10.1007/s00381-021-05370-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM Shunt dysfunction is a common event, especially in children who have this intervention performed early in life. The consequences of chronic shunt overdrainage can be multiple since the cerebral hydrodynamics is altered. A thrombotic event with consequent symptoms of intracranial hypertension is discussed in this article. MATERIAL AND METHODS We performed a detailed review of cerebral hydrodynamics and intracranial pressure compensation mechanisms and how this can alter cerebral venous circulation. Next, we report the case of a 4-year-old child with such a clinical presentation that was conducted by our team. RESULTS A child with a history of hydrocephalus treated with a ventriculo-peritoneal (VP) shunt in his early childhood presented with symptoms of intracranial hypertension, initial computed tomography (CT) demonstrating reduced-sized ventricles. Complementary investigation showed bilateral papilledema, cranial suture closure, changes compatible with Chiari type I, and venous sinus thrombosis (transverse and sigmoid, bilaterally). The case was managed conservatively with full anticoagulation with enoxaparin. Four months after the onset of symptoms, there was an improvement in the clinical and imaging status. CONCLUSION A condition of severe headache in a patient with an apparently functioning shunt and small ventricles on initial CT should open up a range of diagnostic possibilities, with pseudotumor cerebri syndrome and cerebral venous sinus thrombosis being suggested. The therapeutic approach in these cases must be individualized.
Collapse
Affiliation(s)
- L C Azevedo Almeida
- Centre for Neurology and Neurosurgery, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
| | - B Silva Costa
- Centre for Neurology and Neurosurgery, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - F B Faraj de Lima
- Centre for Neurology and Neurosurgery, Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
44
|
Rodrigues SG, Vieira D, Bernardo F, Coelho J, Ribeiro JA, Palavra F, Robalo C, Levy A, Quintas S. Pediatric cerebral sinus venous thrombosis: clinical characterization of a Portuguese cohort. Acta Neurol Belg 2021; 122:1211-1218. [PMID: 34606070 DOI: 10.1007/s13760-021-01807-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pediatric cerebral sinus venous thrombosis (CSVT) is a rare entity. Risk factors differ from the adults, and treatment is not consensual. With this work, we aimed to characterize a pediatric cohort from two Portuguese tertiary centers. METHODS All patients under 18 years old with confirmed CSVT admitted between 2006 and 2019 were retrospectively included. Demographics, clinical presentation, workup, and follow-up were evaluated. RESULTS Fifty-three patients were included, 29 were male (54.7%). Median age was 5 years (IQR 11.08, range 0-17 years old). Headache, seizures and impairment of consciousness were the most frequent manifestations. A risk factor was identified in 90.6% (n = 48), mostly infections (43.8%; n = 21). CNS complications were comprised of hemorrhage, venous infarction, hydrocephalus and edema. Treatment included anticoagulation in 36 patients (67.9%), and there were no recurrences on follow-up. Prognosis was favorable, with most patients presenting no or only slight disability comparing to same age and sex children, on the follow-up. DISCUSSION In this cohort, impairment of consciousness was the most frequent clinical presentation and infections were the most frequent risk factors. The outcome was mainly favorable, with most patients presenting none or mild disability and without recurrences on follow-up. Studies are needed to define the criteria for anticoagulation and its recommended duration in children.
Collapse
|
45
|
Aardoom MA, Klomberg RCW, Kemos P, Ruemmele FM, van Ommen CH(H, de Ridder L, Croft NM. The Incidence and Characteristics of Venous Thromboembolisms in Paediatric-Onset Inflammatory Bowel Disease: A Prospective International Cohort Study Based on the PIBD-SETQuality Safety Registry. J Crohns Colitis 2021; 16:695-707. [PMID: 34599822 PMCID: PMC9228884 DOI: 10.1093/ecco-jcc/jjab171] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Guidelines regarding thromboprophylaxis for venous thromboembolisms [VTEs] in children with inflammatory bowel disease [IBD] are based on limited paediatric evidence. We aimed to prospectively assess the incidence of VTEs in paediatric-onset IBD [PIBD], characterize PIBD patients with a VTE and identify potential IBD-related risk factors. METHODS From October 2016 to September 2020, paediatric gastroenterologists prospectively replied to the international Safety Registry, monthly indicating whether they had observed a VTE case in a patient <19 years with IBD. IBD details [type, Paris classification, clinical and biochemical disease activity, treatment] and VTE details [type, location, treatment, outcome] were collected. To estimate VTE incidence, participants annually reported the number of PIBD patients, data source and catchment area of their centre. A systematic literature review and meta-analysis was performed to calculate the VTE incidence in the general paediatric population. RESULTS Participation of 129 PIBD centres resulted in coverage of 24 802 PIBD patients. Twenty cases of VTE were identified [30% Crohn's disease]. The incidence of VTEs was 3.72 (95% confidence interval [CI] 2.27-5.74) per 10 000 person-years, 14-fold higher than in the general paediatric population (0.27 [95% CI 0.18-0.38], p < 0.001). Cerebral sinus venous thrombosis was most frequently reported [50%]. All but one patient had active IBD, 45% were using steroids and 45% were hospitalized. No patient received thromboprophylaxis, whereas according to current PIBD guidelines, this was recommended in 4/20 patients. CONCLUSION There is an increased risk of VTEs in the PIBD population compared to the general paediatric population. Awareness of VTE occurrence and prevention should be extended to all PIBD patients with active disease, especially those hospitalized.
Collapse
Affiliation(s)
| | | | - Polychronis Kemos
- Paediatric Gastroenterology, Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Frank M Ruemmele
- Department of Paediatric Gastroenterology, Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France
| | | | - C H (Heleen) van Ommen
- Department of Paediatric Haematology, Erasmus Medical Centre – Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Lissy de Ridder
- Corresponding author: Dr Lissy de Ridder, MD PhD, Erasmus Medical Center – Sophia Children’s Hospital, Department of Paediatric Gastroenterology, Room SP-2430, PO Box 2040, 3000 CA Rotterdam, the Netherlands. Tel: 0031650001782;
| | | | | |
Collapse
|
46
|
Cerebral Venous Sinus Thrombosis due to Iron Deficiency Anemia in an Adolescent Girl. Case Rep Pediatr 2021; 2021:9979078. [PMID: 34336340 PMCID: PMC8315891 DOI: 10.1155/2021/9979078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is rare but now increasingly diagnosed in children. Early diagnosis is of prime importance as any delay leads to significant mortality and morbidity. It requires a high index of suspicion to diagnose CVST early as, often, the symptoms are vague and the signs are nonspecific. Varieties of aetiologies are described for generation of cerebral venous sinus thrombus. Iron deficiency anemia is one of the most important preventable causes of CVST. The most proposed mechanism in development of CVST in iron deficiency is secondary thrombocytosis. However, we describe a case of CVST due to iron deficiency in the absence of thrombocytosis.
Collapse
|
47
|
Moiz B, Ukrani RD, Arif A, Akbar I, Sadiq MW, Altaf S. Case Study of Pediatric Cerebral Sinus Venous Thrombosis Center of a Low Middle-Income Country. Clin Appl Thromb Hemost 2021; 27:10760296211022847. [PMID: 34137283 PMCID: PMC8216340 DOI: 10.1177/10760296211022847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pediatric cerebral venous sinus thrombosis (CVST) is rare but a potentially fatal disease requiring its understanding in local setting. In this study, we observed the clinical course, management, and outcome of pediatric patients with sinus thrombosis in a tertiary care center at Pakistan. Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were included. Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Of 143492 pediatric admissions, 32 (21 males and 11 females) patients with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 18.5 CVST events per million pediatric admissions. Adolescents were mostly affected, and the overall mortality was 7%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Activated protein C resistance (44%) was the most common inherited thrombophilia. Twenty-one (66%) patients were anemic with a mean (±SD) hemoglobin of 9.0 g/dL (±2.3). Regression analysis showed a positive association of anemia with multiple sinus involvement (P-value 0.009) but not with duration of symptoms (P-value 0.344), hospital stay (P-value 0.466), age (P-value 0.863) or gender (P-value 0.542) of the patients. SARS-COV2 was negative in patients during 2020. Adolescents were primarily affected by sinus thrombosis and infections was the predominant risk factor for all age groups, with a low all-cause mortality. A high index of clinical suspicion is required for prompt diagnosis and intervention.
Collapse
Affiliation(s)
- Bushra Moiz
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Aiman Arif
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Inaara Akbar
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Sadaf Altaf
- Department of Oncology, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
48
|
Fontana A, Greco F, Smilari P, Praticò AD, Fiumara A, Ruggieri M, Pavone P. Anti-MOG Antibody Syndrome and Cerebral Sinovenous Thrombosis: A Cause–Effect Hypothesis. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1716345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractCerebral venous thrombosis is an uncommon event of stroke in childhood. Its origin is multifactorial and often it manifests with nonspecific symptoms that may overlap with underlying predisposing factors. Anti–myelin oligodendrocyte glycoprotein (MOG) antibody syndrome is a group of recently recognized acquired demyelinating diseases that occur more commonly in children, usually, with a favorable outcome. The association between cerebral venous thrombosis and demyelinating syndrome has been reported but their clinical relationship is matter of debate and various hypotheses have been advanced including intravenous (IV) steroid therapy and/or the consequence of a shared inflammatory-thrombotic process. Herein, we report the case of a child with anti-MOG antibody syndromes who developed a thrombosis of the superior sagittal sinus and of the right Trolard's vein.
Collapse
Affiliation(s)
- Alessandra Fontana
- Department of Clinical and Experimental Medicine, Postgraduate Training Program in Pediatrics, University of Catania, Catania, Italy
| | - Filippo Greco
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Pierluigi Smilari
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Andrea D. Praticò
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Agata Fiumara
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Piero Pavone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| |
Collapse
|
49
|
Abstract
Neurovascular disorders are an important cause of brain injury in the paediatric population, leading to substantial mortality and morbidity. These include ischaemic, haemorrhagic strokes, and cerebral venous sinus thromboses. Despite remarkable improvements in our understanding and management of strokes in general, and in the quality of immediate care and rehabilitation, the outcomes in childhood strokes lag far behind adult strokes. This is a multifaceted problem. There remain several challenges including delays in recognition due to vague clinical presentations, a failure to consider strokes in many cases, delays in obtaining imaging and inadequate imaging when performed, as well as limited evidence and availability for hyper acute intervention in children. Stroke in children is also a vastly different entity to adult strokes, with a unique set of risk factors and often with an underlying cause to be found. This review is by no means exhaustive, but instead aims to provide an overview of the epidemiology, sub-classification and aetiology of paediatric neurovascular disorders, mainly ischaemic, haemorrhagic strokes and cerebral venous sinus thrombosis. We also focus on the risk factors for each of these, the clinical presentation, recommended diagnostic protocol, pertinent imaging findings, as well as the current treatment and follow-up practices.
Collapse
Affiliation(s)
- Richa Sinha
- Department of Neuroradiology, Royal Preston Hospital, Preston, UK
| | - Saipriya Ramji
- Department of Neuroradiology, Charing Cross Hospital, London, UK
| |
Collapse
|
50
|
Russ JB, Simmons R, Glass HC. Neonatal Encephalopathy: Beyond Hypoxic-Ischemic Encephalopathy. Neoreviews 2021; 22:e148-e162. [PMID: 33649088 DOI: 10.1542/neo.22-3-e148] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neonatal encephalopathy is a clinical syndrome of neurologic dysfunction that encompasses a broad spectrum of symptoms and severity, from mild irritability and feeding difficulties to coma and seizures. It is vital for providers to understand that the term "neonatal encephalopathy" is simply a description of the neonate's neurologic status that is agnostic to the underlying etiology. Unfortunately, hypoxic-ischemic encephalopathy (HIE) has become common vernacular to describe any neonate with encephalopathy, but this can be misleading. The term should not be used unless there is evidence of perinatal asphyxia as the primary cause of encephalopathy. HIE is a common cause of neonatal encephalopathy; the differential diagnosis also includes conditions with infectious, vascular, epileptic, genetic/congenital, metabolic, and toxic causes. Because neonatal encephalopathy is estimated to affect 2 to 6 per 1,000 term births, of which HIE accounts for approximately 1.5 per 1,000 term births, (1)(2)(3)(4)(5)(6) neonatologists and child neurologists should familiarize themselves with the evaluation, diagnosis, and treatment of the diverse causes of neonatal encephalopathy. This review begins by discussing HIE, but also helps practitioners extend the differential to consider the broad array of other causes of neonatal encephalopathy, emphasizing the epidemiology, neurologic presentations, diagnostics, imaging findings, and therapeutic strategies for each potential category.
Collapse
Affiliation(s)
| | | | - Hannah C Glass
- Division of Child Neurology and.,Department of Pediatrics.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| |
Collapse
|