ORIGINAL ARTICLES

Cerebral venous sinus thrombosis: a case series including thrombolysis

A A Mallick¹, P M Sharples¹, S E Calvert², R W A Jones³, M Leary¹, A L Lux¹, F J O’Callaghan¹, J P Osborne⁴, J S Patel¹, A T Prendiville⁵, S Renowden⁶, P E Jardine¹

¹ Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK
² Department of Paediatric Neurology, Royal Children’s Hospital, Brisbane, Australia
³ Department of Paediatrics, Derriford Hospital, Plymouth, UK
⁴ Department of Paediatrics, Royal United Hospital, Bath, UK
⁵ Department of Paediatrics, Royal Cornwall Hospital, Truro, UK
⁶ Department of Neuroradiology, Frenchay Hospital, Bristol, UK

^{Correspondence to} P E Jardine, Department of Paediatric Neurology, Level 6 UHB Education Centre, Upper Maudlin Street, Bristol BS2 8AE, UK; Philip.Jardine{at}bristol.ac.uk

Background: Cerebral venous sinus thrombosis (CVST) in children is associated with a high incidence of serious morbidity and mortality. The presenting features are variable. It can be diagnostically challenging and the optimal treatment is uncertain.

Aim: To describe the features of a series of children with CVST treated in a single paediatric neurology centre and to discuss the role of local thrombolysis.

Methods: Electronic databases were searched using diagnostic labels and International Classification of Diseases (ICD) codes to identify children aged 1 month to under 17 years with CVST. Their records were reviewed.

Results: 21 children were identified over a period of 8.25 years with a median age of 7.1 years. The presenting symptoms included headache (15 children), vomiting (14 children) and visual disturbance (eight children). Signs found included papilloedema (16 children), fever (six children) and sixth nerve palsy (six children). The most common underlying condition was middle ear infection (13 children). All cases received unfractionated heparin and four severe cases received local pharmacological thrombolysis. 48% of cases had an adverse outcome (death, chronic intracranial hypertension, residual hemiparesis or sixth nerve palsy).

Discussion: CVST has non-specific presenting features and a high risk of significant morbidity. CVST is typically found in association with a predisposing condition. Although heparin is the mainstay of treatment, thrombolysis may reverse deterioration as seen in three cases in this series. However, there is insufficient evidence to recommend the routine use of thrombolysis at present.

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