Benefits of Prolonged Anticoagulant Treatment in a Series of Cerebral Venous Thrombosis in Pediatric Patients

Abstract

Background: Cerebral sinus venous thrombosis (CSVT) is a rare complication in children, usually secondary to an underlying condition. Recent guidelines recommend treating all pediatric patients with CSVT, but also suggest that treatment longer than three months should not be justified in provoked cases in which the risk factor has disappeared. Methods: Retrospective observational study analyzing data of CSVT in children (1-18 years-old) admitted in a single hospital. Demographic data, clinical presentation, etiology, extension, treatment and outcome were evaluated. Results: Thirty-one patients had a confirmed CSVT. Sixteen were girls, mean age was 7.3 years (SD 4.39). Sigmoid sinus (n=17) and transverse sinus (n=14) were the most frequent sinuses affected. Multiple sinus thrombosis was found in 20 patients (64.5%). Underlying condition was described in 29 cases: infectious disease (n=20), major head trauma (n=4), chemotherapy (n=3), arteriovenous malformation (n=2). More frequent symptoms were: headache (n= 15), decreased level of consciousness (n=5), seizures (n=3), focal neurological deficit (n=2), papilledema (n=2), diplopia (n=2), vision impairment (n=1), and coma (n=4). All patients received anticoagulant treatment. Complete vein recanalization after 3 months was achieved in 53.3% of the cases. Treatment was prolonged up to 6 months in those patients with partial or no response (n=14). Seven of them improved radiological findings. Complete and partial vein recanalization were reported in 73.3% and 20% of the patients. Conclusion: Anticoagulation was useful to achieve complete vein recanalization in this series. Extending anticoagulation up to 6 months could be useful to improve outcome of pediatric patients with CSVT in selected cases.