Cerebral sinovenous thrombosis in children.

Background: Cerebral sinovenous thrombosis in children is a serious disorde r, and information is needed about its prevention and treatment. Methods: The Canadian Pediatric Ischemic Stroke Registry was initiated in 1 992 at the 16 pediatric tertiary care centers in Canada. Children (newborn to 18 years of age) with symptoms and radiographic confirmation of sinoveno us thrombosis were included. Results: During the first six years of the registry, 160 consecutive childr en with sinovenous thrombosis were enrolled, and the incidence of the disor der was 0.67 case per 100,000 children per year. Neonates were most commonl y affected. Fifty-eight percent of the children had seizures, 76 percent ha d diffuse neurologic signs, and 42 percent had focal neurologic signs. Risk factors included head and neck disorders (in 29 percent), acute systemic i llnesses (in 54 percent), chronic systemic diseases (in 36 percent), and pr othrombotic states (in 41 percent). Venous infarcts occurred in 41 percent of the children. Fifty-three percent of the children received antithromboti c agents. Neurologic deficits were present in 38 percent of the children, a nd 8 percent died; half the deaths were due to sinovenous thrombosis. Predi ctors of adverse neurologic outcomes were seizures at presentation and veno us infarcts. Conclusions: Sinovenous thrombosis in children affects primarily neonates a nd results in neurologic impairment or death in approximately half the case s. The occurrence of venous infarcts or seizures portends a poor outcome. ( N Engl J Med 2001;345:417-23.) Copyright (C) 2001 Massachusetts Medical Soc iety.