Cerebral sinovenous thrombosis in the neonate

Karima C. Fitzgerald, Linda Williams, Bhuwan P. Garg, Karen S. Carvalho, Meredith Golomb

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Background: There are few studies on neonatal cerebral sinovenous thrombosis (SVT). Objectives: To describe the presentations, treatments, and outcomes of neonatal SVT and to assess infarction as a predictor of outcome. Design: Retrospective chart study. Setting: A tertiary pediatric hospital in Indianapolis, Ind. Patients: Forty-two children with neonatal SVT identified using International Classification of Diseases, Ninth Revision code searches from 1986 through June 2005 and review of neurology clinic records. Interventions: None. Main Outcome Measures: Cognitive impairment, motor impairment, and epilepsy at last clinic visit. Results: Gestational or delivery complications or risk factors and comorbid conditions such as dehydration, sepsis, and cardiac defects were common (gestational/delivery factors in 82% [31 of 38 with available maternal data]; comorbid conditions in 62% [26 of the 42]). Twenty-four (57%) presented with seizures. Twenty-five (60%) had infarcts, which were hemorrhagic in 22. Only 27 (64%) of 42 received prothrombotic evaluations; none had persistent deficiencies of protein C, protein S, or antithrombin III. Three (7%) received heparin sodium. All other children received only supportive care. One child died. Outcome data were available for 29 (71%) of the 41 survivors; of these, 23 (79%) had impairment(s). Two were known to be in early intervention, and no further information was available. Of the remaining 27, 16 (59%) had cognitive impairment, 18 (67%) had cerebral palsy, and 11 (41%) had epilepsy. Infarction was associated with the presence of later impairment (P=.03). Conclusions: The presentation of neonatal SVT is often nonspecific, the diagnosis can be difficult to make, treatment beyond supportive care is rarely used, and outcomes can be severe. Further work is needed to develop standardized guidelines for the evaluation and treatment of neonatal SVT.

Original languageEnglish
Pages (from-to)405-409
Number of pages5
JournalArchives of Neurology
Volume63
Issue number3
DOIs
StatePublished - Mar 2006

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Intracranial Thrombosis
Thrombosis
Newborn Infant
Infarction
Epilepsy
Protein C Deficiency
Pediatric Hospitals
Antithrombin III
Protein S
International Classification of Diseases
Cerebral Palsy
Ambulatory Care
Neurology
Dehydration
Tertiary Care Centers
Survivors
Heparin
Sepsis
Seizures
Retrospective Studies

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Cerebral sinovenous thrombosis in the neonate. / Fitzgerald, Karima C.; Williams, Linda; Garg, Bhuwan P.; Carvalho, Karen S.; Golomb, Meredith.

In: Archives of Neurology, Vol. 63, No. 3, 03.2006, p. 405-409.

Research output: Contribution to journalArticle

Fitzgerald, Karima C. ; Williams, Linda ; Garg, Bhuwan P. ; Carvalho, Karen S. ; Golomb, Meredith. / Cerebral sinovenous thrombosis in the neonate. In: Archives of Neurology. 2006 ; Vol. 63, No. 3. pp. 405-409.
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abstract = "Background: There are few studies on neonatal cerebral sinovenous thrombosis (SVT). Objectives: To describe the presentations, treatments, and outcomes of neonatal SVT and to assess infarction as a predictor of outcome. Design: Retrospective chart study. Setting: A tertiary pediatric hospital in Indianapolis, Ind. Patients: Forty-two children with neonatal SVT identified using International Classification of Diseases, Ninth Revision code searches from 1986 through June 2005 and review of neurology clinic records. Interventions: None. Main Outcome Measures: Cognitive impairment, motor impairment, and epilepsy at last clinic visit. Results: Gestational or delivery complications or risk factors and comorbid conditions such as dehydration, sepsis, and cardiac defects were common (gestational/delivery factors in 82{\%} [31 of 38 with available maternal data]; comorbid conditions in 62{\%} [26 of the 42]). Twenty-four (57{\%}) presented with seizures. Twenty-five (60{\%}) had infarcts, which were hemorrhagic in 22. Only 27 (64{\%}) of 42 received prothrombotic evaluations; none had persistent deficiencies of protein C, protein S, or antithrombin III. Three (7{\%}) received heparin sodium. All other children received only supportive care. One child died. Outcome data were available for 29 (71{\%}) of the 41 survivors; of these, 23 (79{\%}) had impairment(s). Two were known to be in early intervention, and no further information was available. Of the remaining 27, 16 (59{\%}) had cognitive impairment, 18 (67{\%}) had cerebral palsy, and 11 (41{\%}) had epilepsy. Infarction was associated with the presence of later impairment (P=.03). Conclusions: The presentation of neonatal SVT is often nonspecific, the diagnosis can be difficult to make, treatment beyond supportive care is rarely used, and outcomes can be severe. Further work is needed to develop standardized guidelines for the evaluation and treatment of neonatal SVT.",
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