Gabrielle deVeber, M.D., Maureen Andrew, M.D., Coleen Adams, M.B., Bruce Bjornson, M.D., Frances Booth, M.D., David J. Buckley, M.B., Ch.B., Carol S. Camfield, M.D., Michele David, M.D., Peter Humphreys, M.D., Pierre Langevin, M.D., E. Athen MacDonald, M.D., Brandon Meaney, M.D., Michael Shevell, M.D., C.M., D. Barry Sinclair, M.D., Jerome Yager, M.D., Jane Gillett, M.D., for the Canadian Pediatric Ischemic Stroke Study Group
Background Cerebral sinovenous thrombosis in children is a seriousdisorder, and information is needed about its prevention andtreatment.
Methods The Canadian Pediatric Ischemic Stroke Registry wasinitiated in 1992 at the 16 pediatric tertiary care centersin Canada. Children (newborn to 18 years of age) with symptomsand radiographic confirmation of sinovenous thrombosis wereincluded.
Results During the first six years of the registry, 160 consecutivechildren with sinovenous thrombosis were enrolled, and the incidenceof the disorder was 0.67 case per 100,000 children per year.Neonates were most commonly affected. Fifty-eight percent ofthe children had seizures, 76 percent had diffuse neurologicsigns, and 42 percent had focal neurologic signs. Risk factorsincluded head and neck disorders (in 29 percent), acute systemicillnesses (in 54 percent), chronic systemic diseases (in 36percent), and prothrombotic states (in 41 percent). Venous infarctsoccurred in 41 percent of the children. Fifty-three percentof the children received antithrombotic agents. Neurologic deficitswere present in 38 percent of the children, and 8 percent died;half the deaths were due to sinovenous thrombosis. Predictorsof adverse neurologic outcomes were seizures at presentationand venous infarcts.
Conclusions Sinovenous thrombosis in children affects primarilyneonates and results in neurologic impairment or death in approximatelyhalf the cases. The occurrence of venous infarcts or seizuresportends a poor outcome.
Source Information
From the Divisions of Neurology (G.D.) and Hematology–Oncology (M.A.), the Population Health Sciences Program, Hospital for Sick Children, Toronto; the Department of Pediatrics, University of Toronto, Toronto (G.D., M.A.); the Department of Pediatrics, University of Calgary, Calgary, Alta. (C.A.); the Department of Pediatrics, University of British Columbia, Vancouver (B.B.); the Department of Pediatrics, University of Manitoba, Winnipeg (F.B.); the Department of Pediatrics, Memorial University, St. John's, Nfld. (D.J.B.); the Department of Pediatrics, Dalhousie University, Halifax, N.S. (C.S.C.); the Department of Hematology–Oncology, Université de Montreal, Montreal (M.D.); the Department of Pediatrics, University of Ottawa, Ottawa, Ont. (P.H.); the Department of Pediatric Neurology, Centre Hospitalier de l'Université Laval, Sainte-Foy, Quebec, Que. (P.L.); the Department of Pediatrics, Queen's University, Kingston, Ont. (E.A.M.); and the Departments of Pediatrics and Clinical Neurosciences, University of Western Ontario, London (J.G.) — all in Canada.
Other authors were Brandon Meaney, M.D. (Department of Pediatrics, McMaster University, Hamilton, Ont.), Michael Shevell, M.D., C.M. (Department of Neurology, Pediatrics, and Neurosurgery, McGill University, Montreal), D. Barry Sinclair, M.D. (Department of Pediatrics, University of Alberta, Edmonton), and Jerome Yager, M.D. (Department of Pediatrics, University of Saskatchewan, Saskatoon).
Address reprint requests to Dr. deVeber at the Division of Neurology, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada.
Coutinho, J. M., Ferro, J. M., Canhao, P., Barinagarrementeria, F., Cantu, C., Bousser, M.-G., Stam, J.
(2009). Cerebral Venous and Sinus Thrombosis in Women. Stroke
40: 2356-2361
[Abstract][Full Text]
Aden, U.
(2009). Neonatal Stroke Is Not a Harmless Condition. Stroke
40: 1948-1949
[Full Text]
Linn, J., Pfefferkorn, T., Ivanicova, K., Muller-Schunk, S., Hartz, S., Wiesmann, M., Dichgans, M., Bruckmann, H.
(2009). Noncontrast CT in Deep Cerebral Venous Thrombosis and Sinus Thrombosis: Comparison of its Diagnostic Value for Both Entities. Am. J. Neuroradiol.
30: 728-735
[Abstract][Full Text]
Kiessling, J. W., Cines, D. B., Higazi, A. A.-R., Armstead, W. M.
(2009). Inhibition of integrin {alpha}V{beta}3 prevents urokinase plasminogen activator-mediated impairment of cerebrovasodilation after cerebral hypoxia/ischemia. Am. J. Physiol. Heart Circ. Physiol.
296: H862-H867
[Abstract][Full Text]
Cheung, H M, Chu, W C W, Lam, H S, Ng, P C
(2009). Rapid diagnosis of cerebral sinovenous thrombosis complicating group B streptococcus meningitis by multidetector CT venography. BMJ Case Reports
2009: bcr2007136903-bcr2007136903
[Full Text]
Lo, W., Stephens, J., Fernandez, S.
(2009). Pediatric Stroke in the United States and the Impact of Risk Factors. J Child Neurol
24: 194-203
[Abstract]
Prasad, S., Liu, G. T, Abend, N. S, Ichord, R. N
(2009). Images in paediatrics: Sinovenous thrombosis due to mastoiditis. BMJ Case Reports
2009: bcr2007123737-bcr2007123737
[Full Text]
Haug, V., Linder-Lucht, M., Zieger, B., Korinthenberg, R., Mall, V., Mader, I.
(2009). Unilateral Venous Thalamic Infarction in a Child Mimicking a Thalamic Tumor. J Child Neurol
24: 105-109
[Abstract]
Beslow, L. A., Abend, N. S., Smith, S. E.
(2009). Cerebral Sinus Venous Thrombosis Complicated by Cerebellar Hemorrhage in a Child With Acute Promyelocytic Leukemia. J Child Neurol
24: 110-114
[Abstract]
Simchen, M. J., Goldstein, G., Lubetsky, A., Strauss, T., Schiff, E., Kenet, G.
(2009). Factor V Leiden and Antiphospholipid Antibodies in Either Mothers or Infants Increase the Risk for Perinatal Arterial Ischemic Stroke. Stroke
40: 65-70
[Abstract][Full Text]
Domi, T., Edgell, D. S., McCrindle, B. W., Williams, W. G., Chan, A. K., MacGregor, D. L., Kirton, A., deVeber, G. A.
(2008). Frequency, Predictors, and Neurologic Outcomes of Vaso-occlusive Strokes Associated With Cardiac Surgery in Children. Pediatrics
122: 1292-1298
[Abstract][Full Text]
Teksam, M., Moharir, M., deVeber, G., Shroff, M.
(2008). Frequency and Topographic Distribution of Brain Lesions in Pediatric Cerebral Venous Thrombosis. Am. J. Neuroradiol.
29: 1961-1965
[Abstract][Full Text]
Pappachan, J, Kirkham, F J
(2008). Cerebrovascular disease and stroke. Arch. Dis. Child.
93: 890-898
[Abstract][Full Text]
Young, G., Albisetti, M., Bonduel, M., Brandao, L., Chan, A., Friedrichs, F., Goldenberg, N. A., Grabowski, E., Heller, C., Journeycake, J., Kenet, G., Krumpel, A., Kurnik, K., Lubetsky, A., Male, C., Manco-Johnson, M., Mathew, P., Monagle, P., van Ommen, H., Simioni, P., Svirin, P., Tormene, D., Nowak-Gottl, U.
(2008). Impact of Inherited Thrombophilia on Venous Thromboembolism in Children: A Systematic Review and Meta-Analysis of Observational Studies. Circulation
118: 1373-1382
[Abstract][Full Text]
Roach, E. S., Golomb, M. R., Adams, R., Biller, J., Daniels, S., deVeber, G., Ferriero, D., Jones, B. V., Kirkham, F. J., Scott, R. M., Smith, E. R.
(2008). Management of Stroke in Infants and Children: A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke
39: 2644-2691
[Abstract][Full Text]
Wasay, M., Kamal, A. K.
(2008). Anticoagulation in Cerebral Venous Sinus Thrombosis: Are We Treating Ourselves?. Arch Neurol
65: 985-987
[Full Text]
Cheung, H M, Chu, W C W, Lam, H S, Ng, P C
(2008). Rapid diagnosis of cerebral sinovenous thrombosis complicating group B streptococcus meningitis by multidetector CT venography. Arch. Dis. Child. Fetal Neonatal Ed.
93: F304-F304
[Full Text]
Monagle, P., Chalmers, E., Chan, A., deVeber, G., Kirkham, F., Massicotte, P., Michelson, A. D.
(2008). Antithrombotic Therapy in Neonates and Children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest
133: 887S-968S
[Abstract][Full Text]
Stam, J., Majoie, C. B.L.M., van Delden, O. M., van Lienden, K. P., Reekers, J. A.
(2008). Endovascular Thrombectomy and Thrombolysis for Severe Cerebral Sinus Thrombosis: A Prospective Study. Stroke
39: 1487-1490
[Abstract][Full Text]
Standridge, S., de los Reyes, E.
(2008). Inflammatory Bowel Disease and Cerebrovascular Arterial and Venous Thromboembolic Events in 4 Pediatric Patients: A Case Series and Review of the Literature. J Child Neurol
23: 59-66
[Abstract]
Blevins, B., Evans, A. K., Moore, R. T., Dobson, N. R.
(2008). Index of suspicion in the nursery. NeoReviews
9: e39-e41
[Full Text]
Maguire, J. L., deVeber, G., Parkin, P. C.
(2007). Association Between Iron-Deficiency Anemia and Stroke in Young Children. Pediatrics
120: 1053-1057
[Abstract][Full Text]
Riordan, T.
(2007). Human Infection with Fusobacterium necrophorum (Necrobacillosis), with a Focus on Lemierre's Syndrome. Clin. Microbiol. Rev.
20: 622-659
[Abstract][Full Text]
McLinden, A., Baird, A. D., Westmacott, R., Anderson, P. E., deVeber, G.
(2007). Early Cognitive Outcome After Neonatal Stroke. J Child Neurol
22: 1111-1116
[Abstract]
Raju, T. N.K., Nelson, K. B., Ferriero, D., Lynch, J. K., and the NICHD-NINDS Perinatal Stroke Workshop Part,
(2007). Ischemic Perinatal Stroke: Summary of a Workshop Sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. Pediatrics
120: 609-616
[Abstract][Full Text]
Prasad, S., Liu, G. T, Abend, N. S, Ichord, R. N
(2007). Images in paediatrics: Sinovenous thrombosis due to mastoiditis. Arch. Dis. Child.
92: 749-749
[Full Text]
Fitzgerald, K. C., Golomb, M. R.
(2007). Neonatal Arterial Ischemic Stroke and Sinovenous Thrombosis Associated With Meningitis. J Child Neurol
22: 818-822
[Abstract]
Ozyurek, E., Balta, G., Degerliyurt, A., Parlak, H., Aysun, S., Gurgey, A.
(2007). Significance of Factor V, Prothrombin, MTHFR, and PAI-1 Genotypes in Childhood Cerebral Thrombosis. CLIN APPL THROMB HEMOST
13: 154-160
[Abstract]
Dabscheck, G., Mackay, M., Coleman, L., Lo, P.
(2007). Isolated Intracranial Hypertension as a Late Manifestation of Sinus Venous Compression Secondary to a Depressed Skull Fracture. J Child Neurol
22: 344-347
[Abstract]
Golomb, M. R., Garg, B. P., Williams, L. S.
(2007). Accuracy of ICD-9 Codes for Identifying Children With Cerebral Sinovenous Thrombosis. J Child Neurol
22: 45-48
[Abstract]
Widjaja, E., Shroff, M., Blaser, S., Laughlin, S., Raybaud, C.
(2006). 2D Time-of-Flight MR Venography in Neonates: Anatomy and Pitfalls.. Am. J. Neuroradiol.
27: 1913-1918
[Abstract][Full Text]
Caruso, V., Iacoviello, L., Di Castelnuovo, A., Storti, S., Mariani, G., de Gaetano, G., Donati, M. B.
(2006). Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients. Blood
108: 2216-2222
[Abstract][Full Text]
Leach, J. L., Fortuna, R. B., Jones, B. V., Gaskill-Shipley, M. F.
(2006). Imaging of Cerebral Venous Thrombosis: Current Techniques, Spectrum of Findings, and Diagnostic Pitfalls. RadioGraphics
26: S19-S41
[Abstract][Full Text]
Kleindorfer, D., Khoury, J., Kissela, B., Alwell, K., Woo, D., Miller, R., Schneider, A., Moomaw, C., Broderick, J. P.
(2006). Temporal Trends in the Incidence and Case Fatality of Stroke in Children and Adolescents. J Child Neurol
21: 415-418
[Abstract]
Vagefi, M R, Fredrick, D R
(2006). Papilloedema secondary to otitic hydrocephalus. Br. J. Ophthalmol.
90: 646-646
[Full Text]
Fitzgerald, K. C., Williams, L. S., Garg, B. P., Carvalho, K. S., Golomb, M. R.
(2006). Cerebral sinovenous thrombosis in the neonate.. Arch Neurol
63: 405-409
[Abstract][Full Text]
Soman, T. B., Moharir, M., deVeber, G., Weiss, S.
(2006). Infantile Spasms as an Adverse Outcome of Neonatal Cortical Sinovenous Thrombosis. J Child Neurol
21: 126-131
[Abstract]
Kuhle, S., Mitchell, L., Andrew, M., Chan, A. K., Massicotte, P., Adams, M., deVeber, G.
(2006). Urgent Clinical Challenges in Children With Ischemic Stroke: Analysis of 1065 Patients From the 1-800-NOCLOTS Pediatric Stroke Telephone Consultation Service. Stroke
37: 116-122
[Abstract][Full Text]
Comi, A. M., Johnston, M. V., Wilson, M. A.
(2005). Immature Mouse Unilateral Carotid Ligation Model of Stroke. J Child Neurol
20: 980-983
[Abstract]
Armstead, W. M., Cines, D. B., Higazi, A. A.-R.
(2005). Plasminogen Activators Contribute to Impairment of Hypercapnic and Hypotensive Cerebrovasodilation After Cerebral Hypoxia/Ischemia in the Newborn Pig. Stroke
36: 2265-2269
[Abstract][Full Text]
Zahuranec, D. B., Brown, D. L., Lisabeth, L. D., Morgenstern, L. B.
(2005). Is It Time for a Large, Collaborative Study of Pediatric Stroke?. Stroke
36: 1825-1829
[Abstract][Full Text]
Canhao, P., Ferro, J. M., Lindgren, A. G., Bousser, M.-G., Stam, J., Barinagarrementeria, F., for the ISCVT Investigators,
(2005). Causes and Predictors of Death in Cerebral Venous Thrombosis. Stroke
36: 1720-1725
[Abstract][Full Text]
Hetherington, R., Tuff, L., Anderson, P., Miles, B., deVeber, G.
(2005). Short-Term Intellectual Outcome After Arterial Ischemic Stroke and Sinovenous Thrombosis in Childhood and Infancy. J Child Neurol
20: 553-559
[Abstract]
Stam, J.
(2005). Thrombosis of the Cerebral Veins and Sinuses. NEJM
352: 1791-1798
[Full Text]
Sebire, G., Tabarki, B., Saunders, D. E., Leroy, I., Liesner, R., Saint-Martin, C., Husson, B., Williams, A. N., Wade, A., Kirkham, F. J.
(2005). Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain
128: 477-489
[Abstract][Full Text]
Ferriero, D. M.
(2004). Neonatal Brain Injury. NEJM
351: 1985-1995
[Full Text]
Fumagalli, M, Ramenghi, L A, Mosca, F
(2004). Palpebral ecchymosis and cerebral venous thrombosis in a near term infant. Arch. Dis. Child. Fetal Neonatal Ed.
89: F530-F530
[Full Text]
Monagle, P., Chan, A., Massicotte, P., Chalmers, E., Michelson, A. D.
(2004). Antithrombotic Therapy in Children*: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest
126: 645S-687S
[Abstract][Full Text]
Golomb, M. R., Dick, P. T., MacGregor, D. L., Curtis, R., Sofronas, M., deVeber, G. A.
(2004). Neonatal Arterial Ischemic Stroke and Cerebral Sinovenous Thrombosis Are More Commonly Diagnosed in Boys. J Child Neurol
19: 493-497
[Abstract]
Benedict, S. L., Bonkowsky, J. L., Thompson, J. A., Van Orman, C. B., Boyer, R. S., Bale, J. F. JR, Filloux, F. M.
(2004). Cerebral Sinovenous Thrombosis in Children: Another Reason to Treat Iron Deficiency Anemia. J Child Neurol
19: 526-531
[Abstract]
Ferro, J. M., Canhao, P., Stam, J., Bousser, M.-G., Barinagarrementeria, F., for the ISCVT Investigators,
(2004). Prognosis of Cerebral Vein and Dural Sinus Thrombosis: Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke
35: 664-670
[Abstract][Full Text]
Jaremko, J. L., Kirton, A., Brenner, J. L.
(2003). A 12-year-old girl with pharyngitis, meningitis and sinovenous thrombosis. CMAJ
169: 811-812
[Full Text]
Heller, C., Heinecke, A., Junker, R., Knofler, R., Kosch, A., Kurnik, K., Schobess, R., von Eckardstein, A., Strater, R., Zieger, B., Nowak-Gottl, U.
(2003). Cerebral Venous Thrombosis in Children: A Multifactorial Origin. Circulation
108: 1362-1367
[Abstract][Full Text]
Golomb, M. R., deVeber, G. A., MacGregor, D. L., Domi, T., Whyte, H., Stephens, D., Dick, P. T.
(2003). Independent Walking After Neonatal Arterial Ischemic Stroke and Sinovenous Thrombosis. J Child Neurol
18: 530-536
[Abstract]
Tormene, D., Simioni, P., Prandoni, P., Franz, F., Zerbinati, P., Tognin, G., Girolami, A.
(2002). The incidence of venous thromboembolism in thrombophilic children: a prospective cohort study. Blood
100: 2403-2405
[Abstract][Full Text]
Wu, Y. W., Miller, S. P., Chin, K., Collins, A. E., Lomeli, S. C., Chuang, N. A., Barkovich, A. J., Ferriero, D. M.
(2002). Multiple risk factors in neonatal sinovenous thrombosis. Neurology
59: 438-440
[Abstract][Full Text]
Fullerton, H.J., Chetkovich, D.M., Wu, Y.W., Smith, W.S., Johnston, S.C.
(2002). Deaths from stroke in US children, 1979 to 1998. Neurology
59: 34-39
[Abstract][Full Text]
Kao, A., Dlugos, D., Hunter, J. V., Mamula, P., Thorarensen, O.
(2002). Anticoagulation Therapy in Cerebral Sinovenous Thrombosis and Ulcerative Colitis in Children. J Child Neurol
17: 479-482
[Abstract]
Avcin, T, Cimaz, R, Meroni, P L
(2002). Recent advances in antiphospholipid antibodies and antiphospholipid syndromes in pediatric populations. Lupus
11: 4-10
[Abstract]
Meyer, M. A., deVeber, G., David, M., Mitchell, L.
(2001). Cerebral Sinovenous Thrombosis. NEJM
345: 1777-1778
[Full Text]
Previous
