Sinus venous thrombosis in Swiss children

With increasing facilities for neuroimaging, the problem of sinus venous thrombosis (SVT) is realised more frequent. However, little is known about the prevalence in the paediatric population, risk factors and cognitive outcome. We report on the results of the Swiss Neuropaediatric Stroke Registry.

Methods: Since January 2000 a monthly questionnaire asking for children who suffered symptomatic SVT is sent to all Swiss Neuropaediatrician. Included arechildren aged 0 days to 16 years with neurological symptoms and sinus venous thrombosis shown in neuroimaging. For each patient data for risk factors, clinical presentation, diagnostic work up, localisation, treatment and outcome after 6 months is collected. A clinical examination followed 18–24 months after stroke including neurological and neuropsychological testing.

Results: 30 children (22 males, 10 neonates) have been reported. 9 children had associated parenchymal lesions (5 neonates). Reported symptoms in neonates were 6x seizures, 3x abnormal tone 2x apnoe; in children 17x headaches, 7x papilledema, 7x nausea, 6x decreased consciousness 6xophtalmological problems, 3x hemiplegia and 2x seizures. In neonates the following risk factors could be found: asphyxia in 3, coagulopathy in 2 and sepsis in 1; in children infectious disease (otitis/mastoiditis) in 9; systemic immunologic disease in 4, leukaemia in 2, head injury in 1, prothrombotic risk factors in 6 and medications interfering with coagulation in 4. During acute illness 18 children and 1 neonate received heparin (iv or low molecular weight heparin (LMWH) followed by longterm treatment with LMWH in 9 children/1 neonate and coumarines in 7 children. Neurological outcome after 6 months was good in 6 neonates and 17 children. 1 neonate and 2 children had moderate neurological deficits and 2 children died. 2 neonates were lost to follow-up. Longterm-FU was so far possible in 3 neonates (2 were severely and 1 mildly handicapped) and 7 children. All 7 children had IQ within normal levels (mean:99.7) but 6 showed neuropsychological problems especially in short term memory. Conclusions: Neonatal/childhood SVT has an incidence of at least 0.5/100000 children/year in the Swiss population. With a mortality of 7% it is serious disease, despite low long term morbidity. Long term outcome seems to be best in elder children with none or ENT infection as a risk factor.