Cerebral sinovenous thrombosis (CSVT) in neonates is a rare diagnosis that is increasingly being recognised with better neuro-imaging techniques. Since presentation is non-specific, neuro-imaging techniques are needed to confirm the diagnosis. Cranial ultrasound may suggest the diagnosis and Colour Doppler US (CDUS) can also be used for evaluation of cerebral venous sinuses in neonates. CDUS was routinely used in a large cohort of 249 asymptomatic preterm infants with a gestational age of less than 29 weeks, showing CSVT in almost 5%, most often involvement of the transverse sinus (Raet et al Radiology, 2014). The CSVT was confirmed with MRI in the majority.

The presence of associated brain lesions, such as haemorrhagic infarction, carries a worse outcome. The spectrum of associated brain lesions recognised in neonates with CSVT, depends on their gestational age at the time of developing CSVT. Extensive white matter lesions throughout the periventricular white matter are the predominant pattern of injury associated with CSVT in symptomatic preterm infants, while an IVH associated with a predominantly unilateral thalamic haemorrhage and punctate white matter lesions (PWML) are most often seen in the full-term infant.

Routine CDUS in both preterm and full-term infants will provide more insight in the incidence of CSVT. In newborn infants admitted with seizures and/or neonatal encephalopathy CSVT should be part of the differential diagnosis. MRI including magnetic resonance venography (MRV) remains superior to cranial ultrasound and is still required in making the diagnosis of CSVT and to decide whether anticoagulation therapy should be considered.