Radiological diagnosis of cerebral venous thrombosis in paediatric age group by Magnetic resonance venography: Pictorial essay (original) (raw)
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Paediatric cerebral venous thrombosis
Jpma the Journal of the Pakistan Medical Association, 2006
Cerebral venous thrombosis (CVT) in children is a multifactorial serious disease. It is being increasingly diagnosed, mainly because of more sensitive diagnostic procedures and increasing clinical awareness. The clinical manifestations can be life-threatening and cause long-term neurological deficits. Thromboembolism in children is a multifactorial disorder in which both genetic and acquired risk factors play a role. CVT occurs in various clinical settings, including infection, dehydration, renal failure, trauma, cancer and haematological disorder with multiple risk factors. Clinical manifestations of CSVT are non-specific and may be subtle. Most of the clinical scenarios occur at all ages and the clinician should consider this diagnosis in a wide range of acute neurological presentations in childhood. CVT can have an extremely variable clinical presentation, mode of onset, imaging appearance and outcome. Its prognosis remains largely unpredictable. Diffusion and perfusion MRI may play a role in detecting venous congestion and CT or MR venography are now the methods of choice for investigation of cerebral venous thrombosis. The options for treatment of infants and children include standard or low molecular weight heparin for 7-10 days followed by oral anticoagulants for 3-6 months. Specific treatment with anticoagulation is controversial in children, but has been established as appropriate therapy in adults. Anticoagulant treatment with heparin is probably safe and beneficial for children with sinus thrombosis, even those with intracranial haemorrhages.
Review Article Paediatric Cerebral Venous Thrombosis
2000
Cerebral venous thrombosis (CVT) in children is a multifactorial serious disease. It is being increasingly diag- nosed, mainly because of more sensitive diagnostic proce- dures and increasing clinical awareness. The clinical mani- festations can be life-threatening and cause long-term neu- rological deficits. Thromboembolism in children is a multi- factorial disorder in which both genetic and acquired risk factors play a
Cerebral venous thrombosis in neonates and children
Pediatric Neurology, 1992
Twenty-five patients (10 neonates, 15 children) with cerebral venous thromboses diagnosed by magnetic resonance imaging or computed tomography over a 10-year period were reviewed retrospectively. Two groups were analyzed separately because of their differing modes of presentation and outcome. Eighty percent of neonates presented with seizures and the outcomes were unfavorable in more than 50%. Thrombosis usually was associated with an acute systemic illness, such as shock or dehydration. In comparison, headache was the most common mode of presentation in the older children (excluding infants) and their outcomes generally were favorable. Thrombosis in this group usually occurred in the setting of a hypercoagulable state or an infectious process. In both groups, global or focal neurologic findings on initial examination unrelated to increased intracranial pressure correlated with the presence of an infarction on computed tomography or magnetic resonance imaging. Infants and children with infarction due to a deep venous thrombosis often had persistent neurologic disability at subsequent examination. No sequelae were observed in those children and neonates only with thrombosis or with superficial venous infarction. Treatment for both groups was conservative. No patient was anticoagulated specifically for the thrombosis. The good outcomes in most patients suggest that acute anticoagulation may not be indicated.
Cerebral venous thrombosis in children: a multifactorial origin
Circulation, 2003
Background-The present study was performed to assess the association of prothrombotic risk factors and underlying conditions (infections, vascular trauma, immobilization, malignancies, autoimmune diseases, renal diseases, metabolic disorders, obesity, birth asphyxia, cardiac malformations, and use of prothrombotic drugs) with cerebral venous thrombosis (CVT) in children. Methods and Results-From 1995 to 2002, 149 pediatric patients aged newborn to Ͻ18 years (median 6 years) with CVT were consecutively enrolled. In patients and in 149 age-and gender-matched children with similar underlying clinical conditions but without CVT, the factor V G1691A mutation, the factor II G20210A variant, lipoprotein(a) [Lp(a)], protein C, protein S, antithrombin, and antiphospholipid antibodies, as well as associated clinical conditions, were investigated. Eighty-four (56.4%) of the patients had at least 1 prothrombotic risk factor compared with 31 control children (20.8%; PϽ0.0001). In addition, 105 (70.5%) of 149 patients with CVT presented with an underlying predisposing condition. On univariate analysis, factor V, protein C, protein S, and elevated Lp(a) were found to be significantly associated with CVT. However, in multivariate analysis, only the combination of a prothrombotic risk factor with an underlying condition (OR 3.9, 95% CI 1.8 to 8.6), increased Lp(a) (OR 4.1, 95% CI 2.0 to 8.7), and protein C deficiency (OR 11.1, 95% CI 1.2 to 104.4) had independent associations with CVT in the children investigated. Conclusions-CVT in children is a multifactorial disease that, in the majority of cases, results from a combination of prothrombotic risk factors and/or underlying clinical condition. (Circulation. 2003;108:1362-1367.) Key Words: pediatrics Ⅲ lipoproteins Ⅲ thrombosis C erebral venous thrombosis (CVT) in childhood is a serious disease that is being increasingly diagnosed, mainly because of more sensitive diagnostic procedures and increasing clinical awareness of the disease. 1 The clinical presentation shows a wide spectrum of symptoms, eg, seizures, papilledema, headache, lack of consciousness or lethargy, and focal neurological deficits. 1,2 The origin and pathophysiology of CVT in the pediatric population is still poorly understood, mainly because of its low incidence, which is estimated at 0.67 per 100 000 children. 1 The disease is serious, and predisposing and influencing factors should be unraveled to identify patients at risk and to establish treatment regimens in children. Local or systemic infections, 3-6 vascular trauma, 7 cancer, acute lymphoblastic leukemia, drug toxicity, 8 lupus erythematosus, 9 nephrotic syndrome, 10 dehydration, 11 asphyxia, maternal problems during pregnancy, 12 Behçet's disease, 2 and metabolic disorders 13-15 have been described as predisposing factors. Recently published data have suggested that multiple additional factors including prothrombotic risk factors contribute to the symptomatic onset of CVT. 11,16,17 In contrast to childhood venous thrombosis, in which the influence of thrombophilic disorders is now well established, data describing prothrombotic risk factors contributing to the origin of CVT in adults and pediatric patients are still conflicting. 16-29 The present study was performed to assess the role of prothrombotic risk factors in combination with underlying clinical conditions as risk factors for CVT in children. Methods Ethics The present prospective multicenter follow-up study was performed in accordance with the ethical standards established in the updated
Advances in Clinical and Experimental Medicine, 2017
Background. Cerebral venous thrombosis (CVT) is a rare condition which constitutes 0.5-1% of all strokes. The clinical and radiological picture of CVT is non-specific and can mimic other disorders. Objectives. The aim of the study was to retrospectively evaluate and correlate clinical and radiological symptoms presented by patients with CVT, both in the initial and follow-up neurological and neuroimaging examinations, with a special emphasis on diagnostic difficulties. Material and methods. Material consisted of 11 patients with CVT (7 women, 4 men). The average age was 43.5, ranging from 23 to 69 years. Clinical symptoms, laboratory findings, risk factors and the results of neuroimaging examinations including CT, MRI and DSA were retrospectively analyzed and correlated. Results. All subjects developed superficial CVT and 1 also deep CVT, with no parenchymal lesions in 2 cases, non-hemorrhagic infarctions in 3 and hemorrhagic lesions in 6 subjects. The most frequent symptoms were headache, seizures and hemiparesis. The major risk factors were hormonal therapies in women and congenital thrombophilia. Factors influencing the clinical course and outcome the most were location and type of brain lesions, with hemorrhagic cortical infarctions bringing the worst prognosis and being associated with the highest rate of persistent neurological deficits, despite the rate of vessel recanalization. Conclusions. In our opinion, quick diagnosis before parenchymal hemorrhagic lesions are visible on CT is of crucial importance and requires a constant alertness and good cooperation of neurologists and radiologists, especially in emergency settings.
Annals of Neurology, 1992
Seven neonates who presented with either lethargy (four infants) or seizures (three infants) were found by magnetic resonance (MR) phase imaging to have idiopathic cerebral venous thrombosis (CVT). Examination showed only hypotonia or hyperreflexia. The presence of CVT was suggested by unenhanced cranial computed tomographic (CT) scans. Conventional MR T1-and T2-weighted images often indicated more extensive thromboses than were suggested by cranial CT. In all infants, MR phase imaging confirmed thromboses by establishing absence of blood flow in cerebral veins or sinuses. No infant received anticoagulation. Lethargy slowly resolved and seizures did not recur. Normal development has been observed thus far in brief follow-up. The occurrence of seven infants with idiopathic neonatal CVT within a 3-month period indicates that CVT may be a cause of neonatal seizures or lethargy of unclear cause. MR phase imaging provides a powerful, noninvasive means of confirming the diagnosis. Treatment with anticoagulants does not appear necessary. Rivkin MJ, Anderson ML, Kaye EM. Neonatal idiopathic cerebral venous thrombosis: an unrecognized cause of transient seizures or lethargy. Ann Neurol 1992;32:5 1-56 Cerebral venous thrombosis (CVT) has been infrequently observed in neonates 1-61. Although previ-From the Departments of
Cerebral venous thrombosis: diagnosis dilemma
Neurology International, 2011
Cerebral venous thrombosis is increasing common disease in daily practice with sharing clinical nonspecific symptoms. This disorder is potentially lethal but treatable, oftenly it was overlooked in both clinical and radiologic in routine practice. Whenever, clinical suspected, prompt investigation by noninvasive imaging such as conventional technique of CT, MR or advanced modilities such as CTV, MRV will helpful in prompt diagnosis and treatment. These imaging modalities may reveal either direct sign( visualization of intraluminal clot) and indirect signs ( paranchymatous change, intracranial hemorrhage). By using of effective treatment will improve the prognosis of the patient. This review summarizes insights into etiology, incidence, imaging modalities and current of the treatment.
Role of MRI in Evaluation of Cerebral Venous Thrombosis
To evaluate the MR findings of cerebral venous sinus thrombosis using T1W, T2W, FLAIR, DWI, SWI and MR Venogram. A study of 70 patients were carried in the Department of Radio-diagnosis, Deccan college of medical sciences, Hyderabad. Patients from all the age groups including both men and women & confirmed by MRI & MRV were included. Patients who were initially diagnosed as CVT but MRI,MRV were normal, with MR incompatible devices or implants ,with claustrophobia were excluded. In my study Of 70 cases , higher age of occurrence is 25-32,more commonly seen in females in puerperal period with 25 cases ,with common clinical presentation headache , seizure , focal neurological deficit. In my study common sinus thrombosis in combination occurred are superior sagittal thrombosis 40 cases , transverse sinus thrombosis 26 cases , followed by sigmoid sinus thrombosis 20 cases. parenchymal haemorrhage better detected in T1/T2 flair , SWI evaluated additional findings venous congestion , micro haemorrhages , MRV detected all cases in my study. MRI with MRV is extremely helpful in accurate detection of CVT. It also differentiates from cytotoxic and vasogenic oedema. swi helps in detecting micro haemorrhages , clot. Acute stage venous thrombus is iso intense or hypo intense on T1WI and hypo intense on T2WI may be difficult to diagnose on conventional MR imaging. MRV is useful in this stage with pronounced thrombosis detection. MRI with MRV is a very helpful imaging modality in detection of cerebral venous sinus thrombosis. MRI features of superficial T2 hyper intense lesions, intra parenchymal haemorrhage has highest accuracy. SWI useful during the acute phase of CVT. Venous hypertension can be detected at an early stage in CVT showing venous congestion. MRV has the highest accuracy in diagnosing Cerebral venous thrombosis.