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Paediatric cerebral sinovenous thrombosis: findings of the International Paediatric Stroke Study
  1. R N Ichord1,
  2. S L Benedict2,
  3. A K Chan3,
  4. F J Kirkham4,5,
  5. U Nowak-Göttl6
  6. for the International Paediatric Stroke Study Group
  1. 1Department Neurology & Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2Department Neurology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
  3. 3Division of Hematology and Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  4. 4Neurosciences Unit, University College London Institute of Child Health, London, UK
  5. 5University hospital Southampton NHS Foundation Trust, Southampton, UK
  6. 6Department of Pediatric Hematology/Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
  1. Correspondence to Dr Rebecca Ichord, Department Neurology CTRB 10th Fl, Children's Hospital of Philadelphia, 3501 Civic Ctr Blvd, Philadelphia, PA 19104, USA; ichord{at}email.chop.edu

Abstract

Objectives We evaluated clinical features, treatment practices and early outcome in a multicentre cohort of children with cerebral sinovenous thrombosis (CSVT).

Methods Children with CSVT from 10 countries were enrolled from January 2003 to July 2007 in the International Paediatric Stroke Study. We analysed clinical symptoms, underlying conditions, antithrombotic treatment and neurological outcome at hospital discharge in 170 children.

Results Of 170 children enrolled, 60% were male; median age 7.2 years (IQR 2.9–12.4). Headache, altered consciousness, focal deficits and seizures were common presenting clinical features. Infarction affected 37% and intracranial haemorrhage 31%. Risk factors included chronic disease in 50%; acute systemic illness or head/neck disorders 41%; prothrombotic state 20% and other haematological abnormality 19%. Discharge neurological status was normal in 48%, abnormal in 43% and unknown in 5%. Antithrombotic therapy was common, most often low molecular weight heparin was common, with significant regional variation in treatment practices. Mortality was low (4%) and was associated with no anticoagulation but not underlying chronic disease, anatomic extent of thrombosis or intracranial haemorrhage. Abnormal neurological status at discharge or death was associated with decreased level of consciousness at presentation and the presence of an identified prothrombotic state.

Conclusions Our study extends the observations of previously published smaller studies in children with CSVT that this is a morbid disease with diverse underlying causes and risk factors. Divergent treatment practices among highly specialised centres as well as limited data on treatment efficacy and safety suggest that further study of this condition is warranted.

  • Neurology
  • Vascular Disease
  • stroke

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