Trombosis venosas cerebrales en la edad pediátrica: presentación clínica, factores de riesgo, diagnóstico y tratamiento

Abstract

Since its first description at the beginning of the 19th century, greater awareness of this disorder has been achieved, becoming nowadays a recognized but sometimes underdiagnosed cause of ischemic stroke in childhood. AIM. To describe a population of children with cerebral venous thrombosis, analyzing clinical presentation, risk factors, treatment and evolution. A descriptive, retrospective and longitudinal review of children from 0 to 17 years of age diagnosed with sinovenous thrombosis was conducted, during the period of time between 2004 and 2009. Thirty one cases with cerebral sinus thrombosis were identified, 18 of them were boys. Clinical presentation included 18 patients with seizures and 13 with high intracranial pressure. We found infections as a risk factor in 23 patients, 3 newborns with obstetric trauma, 5 patients with prothrombotic states, 4 with chronic systemic diseases, 5 with more than one risk factor and 1 with none. Diagnosis was done by magnetic resonance imaging in 18 patients, computed tomography in 11 and magnetic resonance angiography in the other 2. Regarding location, 16 patients showed compromise of the transverse sinus, 4 of the superior longitudinal sinus, another 4 an affectation of the sigmoid sinus, 2 of the cavernous sinus and 5 with a combination of them. Anticoagulation therapy was done in 21 patients and treatment abstention in 10. None of the patients suffered complications or death due to anticoagulation therapy or sinovenous thrombosis. No recurrent symptomatic thrombosis in long term follow up was found. Sinovenous cerebral thromboses are an important but underestimated cause of stroke in childhood. Clinical suspicion should be high, in patients with risk factors and intracranial hypertension or seizures.